Factors Associated With Wound- and Implant-Related Complications After Surgical Treatment of Ankle Fractures
Smeeing, Diederik P.J.; Briet, Jan P.; van Kessel, Charlotte S.; Segers, Michiel M.; Verleisdonk, Egbert J.; Leenen, Luke P.H.; Houwert, Roderick M.; Hietbrink, Falco
(2018) Journal of Foot and Ankle Surgery, volume 57, issue 5, pp. 942 - 947
(Article)
Abstract
We have described the epidemiology of complications after surgical treatment of ankle fractures and assessed which factors are associated with the most frequent complications. We conducted a retrospective cohort study at 2 level 2 and 1 level 1 trauma center in a single trauma region in the Netherlands. The study
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variables were collected from the electronic medical patient records; all ankle fractures were classified using the Lauge-Hansen classification, and the complications were recorded. A total of 989 patients were included from 3 hospitals, with 173 complications in 156 patients (15.8%). The most frequent complication was wound related, occurring in 101 patients (10.2%). Implant-related complications occurred in 44 patients (4.4%). Other complications, such as cast pressure spots, posttraumatic dystrophy, nonunion, impingement, and pneumonia occurred in 28 patients (2.8%). The 2 most important complications were further analyzed for risk factors. Multivariate analysis showed the risk factors for wound-related complications were advanced age, increased American Society of Anesthesiologists classification, smoking, right side symptomatic, open fracture, and initial external fixation. Most implant-related complications were caused by malreduction (n = 22) or untreated syndesmotic injury (n = 19). Malreduction was associated with supination eversion fractures (p =.059), and untreated syndesmotic injury occurred more often with pronation external rotation fractures (p <.001). The most frequent complications after ankle fracture surgery were wound- and implant-related complications. Postoperative wound-related complications were multifactorial and dependent on a combination of trauma-, patient-, and treatment-related factors. In contrast, implant-related complications resulted from the interaction between the fracture type and subsequent surgical treatment.
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Keywords: implant failure, infection, retrospective cohort, surgery, trauma, Humans, Middle Aged, Risk Factors, Trauma Centers, Male, Ankle Fractures/etiology, Netherlands, Adult, Female, Aged, Retrospective Studies, Postoperative Complications/diagnosis, Fracture Fixation, Internal/adverse effects, Surgery, Orthopedics and Sports Medicine, Journal Article
ISSN: 1067-2516
Publisher: Academic Press Inc.
Note: Publisher Copyright: © 2018 The American College of Foot and Ankle Surgeons Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
(Peer reviewed)