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Risk Factors for Postoperative Infection and Associated Outcomes After Pilon Fracture Fixation: A Propensity-Matched
Crystal Jing1, Julia E Ralph1, Kathleen Chang1
1Duke University School of Medicine, Durham, NC, USA.
Insights
Infection after pilon fracture surgery significantly delays weight-bearing recovery and increases nonunion rates. This study identified infection as a major risk factor impacting patient outcomes following pilon fracture fixation.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Infectious Disease in Orthopedics
Background:
- Pilon fractures are severe injuries often associated with comminution and soft tissue damage.
- Previous research links open/comminuted fractures and diabetes to post-ankle fracture infection.
- Infection risk and its impact on outcomes after pilon fractures remain understudied.
Purpose of the Study:
- To identify risk factors for developing surgical site infections following pilon fractures.
- To assess the impact of infection on postoperative outcomes in pilon fracture patients.
Main Methods:
- Retrospective review of 146 patients with pilon fractures undergoing surgical fixation (2013-2023).
- Inclusion criteria: minimum 6-month follow-up.
- 2:1 propensity score matching created infection and no-infection cohorts for comparative analysis.
Main Results:
- Propensity score matching yielded 24 patients in the no-infection group and 14 in the infection group.
- No significant difference in Gustilo-Anderson or AO-OTA fracture classifications between groups.
- Infection cohort showed significantly longer time to partial weight-bearing (29.6 vs 12.5 weeks, P=.0198) and higher nonunion rates (50.0% vs 4.2%, P<.01).
Conclusions:
- Post-pilon fracture infection significantly delays partial weight-bearing.
- Infection is strongly associated with increased rates of nonunion after pilon fracture surgery.
- Fracture severity classifications did not predict infection, but infection itself worsened outcomes.
Background:
Pilon fractures are complex, often involving severe comminution and soft tissue compromise. Risk factors for infection after ankle fracture definitive fixation have been associated with open and/or comminuted fractures and poorly managed diabetes. However, infection risk following pilon fractures have not been well studied, and the effect of infection on other postoperative outcomes have not been widely discussed. This study aims to identify risk factors for developing infection following pilon fracture and assess the effect of infection on postoperative outcomes.
Methods:
This study was a retrospective review of patients who presented with a pilon fracture and underwent surgical fixation between January 1, 2013, and June 1, 2023. Only patients with at least 6-month follow-up were included. Demographic data and clinical data were collected. A 2:1 propensity score matching was completed to identify infection and no-infection cohorts.
Results:
There were 146 patients included in this study. Following propensity score matching, 2 cohorts were identified, including 24 patients with no infection and 14 patients with infection, following pilon fracture. Gustilo-Anderson classification and AO-Orthopaedic Trauma Association (AO-OTA) Classification did not differ significantly between groups (P > .05). Perioperative characteristics were similar between the 2 cohorts. Mean time to partial weightbearing in weeks was 12.51 (SD 7.6) for the no-infection cohort and 29.61 (SD 28.3) for infection cohort (P = .0198). Mean time to full weightbearing in weeks was 21.06 (SD 9.7) for the no-infection cohort and 35.90 (SD 31.7) for the infection cohort (P = .142). In the infection cohort 50.0% (n = 7) of patients experienced nonunion compared with 4.2% (n = 1) in the no-infection cohort (P < .01).
Conclusion:
Although fracture severity classification was not significantly different between groups, infection significantly negatively affected time to partial weightbearing, time to full weightbearing, and nonunion rates.
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