SLR - January 2013 - Aker
Reference: Miller AG, Margules A, Raikin SM. J Bone Joint Surg Am. 2012 Nov 21;94(22):2047-52.
Scientific Literature Review
Reviewed by: John Aker, DPM
Residency Program: Central Alabama Veteran's Health Care, Montgomery, Alabama
Podiatric Relevance:
Ankle fractures are a common injury in the lower extremity, and unstable ankle fractures treated surgically have been shown to have improved outcomes compared to cast immobilization. However, there are few studies that focus on wound complications following surgical reduction of ankle fractures and none with large numbers of patients. These authors studied the risk factors associated with wound complications following surgical intervention of ankle fractures and hypothesized that comorbidities and open fractures would have a negative effect on wound healing.
Methods:
The study population comprised all ankle fractures that were treated between January 2003 and December 2010 by a single surgeon at a single hospital. All types of ankle fractures were included, while pilon fractures were excluded. Patient demographic characteristics and risk factors were tracked including time to surgery, severity of fracture, comorbidities and compliance. Wound complications were defined as requiring local wound care and oral antibiotics or surgical treatment.
Results:
A total of 478 patients were included in the study. Six (1.25 percent) had wounds requiring surgical debridement and fourteen (2.9 percent) patients required local wound care or oral antibiotics. There were significant associations between wound complications and a history of diabetes (p < 0.001), peripheral neuropathy (p = 0.003), wound-compromising medications (p = 0.011), open fractures (p = 0.05), and poor postoperative compliance (p = 0.027). Patient age was also associated with wound complications (p = 0.045). There was no association between time to surgery (p=0.498), peripheral vascular disease (0.359), or smoking (p=0.539) and complications.
Conclusions:
This is one of the few studies focused on post surgical wound complications following traumatic ankle fracture repair. It adds to the body of knowledge with respect to ankle fractures by the quality of outpatient follow-up and the inclusion of a large number of patients. The results highlight the associated surgical wound complications in medically complex patients. It also reveals the importance of patient compliance for wound healing. Delaying time to surgery for an optimal soft tissue envelope is advised; average time to surgery was nine days in this study.