Risk factors for postoperative infection in patients after pilon fracture fixation

The combination of high energy fractures, extensive soft tissue trauma, and high infection rates in pilon fractures of the distal tibia have long challenged surgeons. Despite the ample evidence, there is no consensus regarding the factors that may influence postoperative infections following surgical management of these fractures. This study aimed to investigate the risk factors for postoperative infections in patients undergoing surgical management for pilon fractures. This retrospective cohort study evaluated demographic variables, smoking status, nutritional status (i.e., pre-and postoperative albumin, pre-and postoperative white blood cell count, use of antibiotics, time to external fixation and ORIF, and hospital length of stay. A multivariate logistic regression model was used to predict risk factors associated with postoperative infection after fixation of a pilon fracture for several independent parameters. A receiver operator characteristic (ROC) curve was constructed, and a threshold was found for the investigated continuous variables, which were significant in the regression analysis. Overall, 416 patients following surgical management for a pilon fracture were identified. A multivariate logistic regression analysis revealed that preoperative albumin, preoperative WBC, and hospital length of stay were associated with postoperative infection following surgical management of pilon fractures. Thresholds determined by the Youden index were 3.05 for preoperative albumin levels, 12.65 for preoperative WBC levels, and 7.1 days for hospital length of stay. Furthermore, older patients were less prone to develop postoperative infection than younger patients. Lower preoperative albumin levels (< 3.05 mg/dL), higher preoperative WBC levels (>12.65 mg/dL), and a longer duration of hospitalization (>7.1 days) were related to an increased risk for postoperative infection after fixation of a pilon fracture.