Risk prediction model for deep surgical site infection (DSSI) following open reduction and internal fixation of displaced intra-articular calcaneal fracture.

Deep surgical site infection (DSSI) is a serious complication affecting the surgical outcome of displaced intra-articular calcaneal fracture, and a risk prediction model based on the identifiable risk factors will provide great clinical value in prevention and prompt interventions. This study retrospectively identified patients operated for calcaneal fracture between January 2014 and December 2019, with a follow-up ≥1 year. The data were extracted from electronic medical records, with regard to demographics, comorbidities, injury, surgery and laboratory biomarkers at admission. Univariate and multivariate logistics regression analyses were used to identify the independent factors for DSSI, thereby the risk prediction model was developed. Among 900 patients included, 2.7% developed a DSSI. The multivariate analyses identified five factors independently associated with DSSI, including current smoking (OR, 2.8; 95% confidence interval [CI], 1.3-6.4; P = .021), BMI ≥ 26.4 kg/m2 (OR, 3.1; 95% CI, 1.6-8.4; P = .003), ASA ≥II (OR, 1.3; 95% CI, 1.0-5.1; P = .043), incision level of II (OR, 3.8; 95% CI, 1.3-12.6; P = .018) and NLR ≥6.4 (OR, 3.2; 95% CI, 1.3-7.5; P = .008). A score of 14 as the optimal cut-off value was corresponding to sensitivity of 0.542 and specificity of 0.872 (area, 0.766; P < .001); ≥14 was associated with 8.1-times increased risk of DSSI; a score of 7 was corresponding sensitivity of 100% and 10 corresponding to sensitivity of 0.875. The risk prediction model exhibited excellent performance in distinguishing the risk of DSSI and could be considered in practice for improvement of wound management, but its validity requires to be verified by better-design studies.

Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra-articular fractures of distal femur: A multicentre study.

There remains a lack of data on the epidemiological characteristics of surgical site infection (SSI) following the open reduction and internal fixation (ORIF) of intra-articular fractures of distal femur, and the aim of this study was to solve this key clinical issue. The electronic medical records (EMRs) of patients who underwent ORIF for distal femoral fracture from January 2013 to December 2017 were reviewed to identify those who developed a SSI. Then, we conducted univariate Chi-square analyses and used a multivariate logistic regression analysis model to determine the adjusted risk factors associated with SSI. A total of 724 patients who underwent ORIF of intra-articular fractures of the distal femur were studied retrospectively, and 29 patients had postoperative SSIs. The overall incidence of SSIs was 4.0% (29/724), with deep SSIs being 1.5% (11/724), and superficial SSIs being 2.5% (18/724). Staphylococcus aureus was the most common causative pathogen (8, 42.1%), followed by mixed bacterial pathogens (5, 26.3%). Open fracture, obesity, smoking, and diabetes mellitus were identified as the adjusted risk factors associated with SSIs. Although modification of these risk factors may be difficult, patients and families should be counselled regarding their increased risk of SSI because these patients potentially benefit from focused perioperative medical optimisation.

[Clinical analysis for fixation failure of 13 patients with intertrochanteric fractures].

OBJECTIVE: To analysis the reasons of fixation failure for intertrochanteric fractures, so as to select correct operation indications and fixation methods. METHODS: Retrospective analysis the clinical data of 13 patients with failed internal fixation of intertrochanteric fractures from September 1997 to September 2008, and the failure reasons were summarized. There were 7 males and 6 females,ranging in age from 58 to 93 years,averaged 71 years. Two patients were treated with intramedullary fixation, 4 patients with anatomical proximal femoral plate, 3 patients with DHS fixation, 2 patients with hollow compression screws, and 2 patients with external fixation. According to Evans types: 1 patient was type II, 7 patients were type III, and 5 patients were type IV. RESULTS: Eight patients with unstable fractures and malreduction had no grafted bone. Six patients had bad position of neck screws in the femur neck. Postoperative collodiaphyseal angle: 3 patients were under 90 degree, 7 patients 90 to 110 degree, and 3 patients 110 to 130 degree. Five patients had internal fixed screw exited, 6 patients had neck screws cutting to superior lateral, 3 patients had early weight bearing, and 10 patients were osteoporosis occurred after operation from 6 weeks to 11 months, averaged 4.5 months. CONCLUSION: The fixation failure of intertrochanteric fractures was concerned with fractures types, reduction, fixation methods, osteoporosis and the time of weight bearing.