Factors Associated With the Development of a Confirmed Fracture-Related Infection

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Public Health

Background:

• Fracture-related infections (FRI) are a significant complication following operative fracture fixation.
• Identifying risk factors is crucial for developing effective prevention and management strategies.
• Previous studies have explored various factors, but a comprehensive analysis is needed.

Purpose of the Study:

• To identify demographic, injury-related, and treatment-associated factors linked to the development of FRI.
• To determine specific risk factors for FRI in patients undergoing operative repair of extremity, shoulder, and pelvic fractures.

Main Methods:

• Retrospective study conducted at an academic medical center.
• Analysis included patients with peripheral extremity, shoulder, and pelvic girdle fractures who underwent operative repair.
• Statistical methods included chi-square, Fisher exact testing, ANOVA, t tests, and binomial logistic regression.

Main Results:

• The FRI cohort included 193 patients, with a significant proportion showing wound breakdown or sinus tracts.
• Factors associated with FRI development included higher Body Mass Index (BMI), Black and Hispanic race, higher American Society of Anesthesiologists (ASA) class, and history of tobacco, alcohol, and drug use.
• Fractures of the lower extremity (foot, tibia, femur/pelvis) and treatment at an urban level I trauma center were also identified as positive predictors of FRI.

Conclusions:

• Higher BMI, specific racial/ethnic groups (Black, Hispanic), higher ASA class, and substance use are significant risk factors for FRI.
• Lower extremity fractures, particularly of the foot, tibia, and femur/pelvis, are associated with an increased risk of FRI.
• These findings highlight the need for targeted interventions and heightened vigilance in high-risk patient populations and fracture types.