Related Experiment Video
Updated: Oct 7, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Risk Factors for Infection and Subsequent Adverse Clinical Results in the Setting of Operatively Treated Pilon
Teja Yeramosu1, Jibanananda Satpathy2, Paul W Perdue2
1Virginia Commonwealth University School of Medicine, Richmond, VA; and.
Insights
Diabetes and severe tibial pilon fractures increase infection risk after surgery. Diabetes and polymicrobial infections predict adverse outcomes, highlighting key factors for managing these complex injuries.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Infectious Disease
Background:
- Tibial pilon fractures are severe injuries requiring operative fixation.
- Fracture-related infections (FRIs) and adverse outcomes are significant complications.
- Predicting these complications is crucial for patient management.
Purpose of the Study:
- To identify patient-specific and injury-specific factors predicting infection and adverse outcomes in tibial pilon fractures.
- To analyze risk factors for developing fracture-related infections.
- To determine predictors of poor clinical results post-operatively.
Main Methods:
- Retrospective chart review of 248 patients undergoing operative treatment for tibial pilon fractures (2010-2020).
- Analysis of external fixation and/or open reduction and internal fixation interventions.
- Evaluation of fracture-related infection rates, bacteriology, and clinical outcomes.
Main Results:
- Overall infection rate was 21%.
- Diabetes mellitus, open fractures, and comminuted fractures (OTA/AO 43C2/43C3) were associated with higher infection risk.
- Polymicrobial infections and history of diabetes predicted adverse clinical results.
Conclusions:
- Diabetes and severe fracture characteristics (open, comminuted) predict fracture-related infections after operative tibial pilon fracture fixation.
- Diabetes history and polymicrobial infections are independently associated with adverse clinical outcomes.
Objective:
To determine patient-specific and injury-specific factors that may predict infection and other adverse clinical results in the setting of tibial pilon fractures.
Design:
Retrospective chart review.
Setting:
Level 1 academic trauma center.
Patients:
Two hundred forty-eight patients who underwent operative treatment for tibial pilon fractures between 2010 and 2020.
Intervention:
External fixation and/or open reduction and internal fixation.
Main Outcome Measurements:
Fracture-related infection rates and specific bacteriology, risk factors associated with development of a fracture-related infection, and predictors of adverse clinical results.
Results:
Two hundred forty-eight patients were enrolled. There was an infection rate of 21%. The 3 most common pathogens cultured were methicillin-resistant Staphylococcus aureus (20.3%), Enterobacter cloacae (16.7%), and methicillin-resistant Staphylococcus aureus (15.5%). There was no significant difference in age, sex, race, body mass index, or smoking status between those who developed an infection and those who did not. Patients with diabetes mellitus ( P = 0.0001), open fractures ( P = 0.0043), and comminuted fractures (OTA/AO 43C2 and 43C3) ( P = 0.0065) were more likely to develop a fracture-related infection. The presence of a polymicrobial infection was positively associated with adverse clinical results ( P = 0.006). History of diabetes was also positively associated with adverse results ( P = 0.019).
Conclusions:
History of diabetes and severe fractures, such as those that were open or comminuted fractures, were positively associated with developing a fracture-related infection after the operative fixation of tibial pilon fractures. History of diabetes and presence of a polymicrobial infection were independently associated with adverse clinical results.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.