Acute Alcohol Intoxication and Chronic Alcohol Use Increase Risk of Infection After Open Tibia Fractures

Alcohol use is a known risk factor for impaired wound healing. This study evaluated the impact of acute and chronic alcohol use on fracture-related infection (FRI) incidence in open tibia fractures.

A retrospective review of skeletally mature patients with open tibia fractures at a level I trauma center from 2017 to 2021 was conducted. Six-month follow-up was required. Missing blood toxicology results were excluded. Ethanol levels >10 mg/dL on admission defined acute alcohol use, and daily alcohol use or documented history defined chronic alcohol use. The primary outcome was FRI. Bivariate and multivariate analyses identified associations between alcohol use and infection rates.

Among 190 fractures (187 patients), 70 (36.8%) developed positive FRI criteria: 15 suggestive, 55 confirmatory. Acute alcohol use and chronic alcohol use were independently associated with suggestive FRI in multivariate analysis (acute: P = .044, odds ratio [OR] 2.96, 95% CI [1.03-8.50]; chronic: P = .022, OR 4.70, 95% CI [1.25-17.70]). In chronic alcohol users, acute alcohol use further increased suggestive FRI risk (P = .036, OR 11.05, 95% CI [1.85-65.86]). Smoking, compartment syndrome, and increasing open fracture severity increased the risk of confirmatory FRI (P = .007, OR 2.30, 95% CI [1.26-4.20]; P = .023, OR 2.75, 95% CI [1.15-6.58]; P = .003, OR 1.57, 95% CI [1.16-2.12], respectively).

Acute and chronic alcohol use significantly increased suggestive FRI risk in open tibia fractures, with compounded risk when both were present. This study examined the relationship between acute alcohol use and FRI in orthopedic trauma, underscoring the need for targeted interventions in this high-risk population.