The Judicious Use of Early Fixation of Closed, Complete Articular Pilon Fractures is Not Associated with Increased Risk of Deep Infection or Wound Complications

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

Download Full-text

Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01580-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jef Van den Eynde ◽

Abel Van Vlasselaer ◽

Annoushka Laenen ◽

Delphine Szecel ◽

Bart Meuris ◽

...

Keyword(s):

Retrospective Study ◽

Hemoglobin A1c ◽

Clinical Decision Making ◽

Artery Bypass ◽

Clinical Decision ◽

Wound Complications ◽

Minimal Risk ◽

Off Pump ◽

Increased Risk ◽

Diabetes Patients

Abstract Background Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). Methods We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. Results During a median follow-up of 326 days (interquartile range (IQR) 21–1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups. Conclusions Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC.

Download Full-text

Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0015

Author(s):

Paolo Ceccarini ◽

Rosario Petruccelli ◽

Michele Bisaccia ◽

Giuseppe Rinonapoli ◽

Auro Caraffa

Keyword(s):

Wound Dehiscence ◽

Deep Infection ◽

Ankle Fractures ◽

Bone Union ◽

Wound Complications ◽

Fisher Exact Test ◽

Superficial Infection ◽

Operative Care ◽

Group B

Category: Ankle; Trauma Introduction/Purpose: The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use. Methods: We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test. Results: At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test). Conclusion: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

Download Full-text

Risk factors of deep infection in operatively treated pilon fractures (AO/OTA: 43)

Journal of Orthopaedics ◽

10.1016/j.jor.2015.01.026 ◽

2015 ◽

Vol 12 ◽

pp. S7-S13 ◽

Cited By ~ 15

Author(s):

Cesar S. Molina ◽

Daniel J. Stinner ◽

Andrew R. Fras ◽

Jason M. Evans

Keyword(s):

Risk Factors ◽

Deep Infection ◽

Pilon Fractures

Download Full-text

Preoperative Risk Factors for Complications in Elective Ankle and Hindfoot Reconstruction

Foot & Ankle Specialist ◽

10.1177/1938640017706155 ◽

2017 ◽

Vol 11 (1) ◽

pp. 54-60 ◽

Cited By ~ 10

Author(s):

Ryan P. Mulligan ◽

Kevin J. McCarthy ◽

Benjamin J. Grear ◽

David R. Richardson ◽

Susan N. Ishikawa ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Chart Review ◽

Reoperation Rate ◽

Deep Infection ◽

Foot And Ankle ◽

Psychological Variables ◽

Reconstruction Methods ◽

Increased Risk ◽

Retrospective Comparative Study ◽

Alcohol Users

Background. The purpose of this study was to examine medical, social, and psychological factors associated with complications and reoperation after foot and ankle reconstruction. Methods. A retrospective chart review was conducted of 132 patients (135 feet; 139 operative cases) who had elective foot and ankle reconstruction. Medical, social, and psychological variables were documented. Primary outcomes included complications and reoperations. Results. The overall complication rate was 28% (39/139), and the reoperation rate was 17% (24/139). Alcohol use (P = .03) and preoperative narcotic use (P = .02) were risk factors for complications, with delayed wound healing more frequent in alcohol users (P = .03) and deep infection (P = .045) and nonunion (P = .046) more frequent preoperative narcotic use. Deep infection also was more frequent in tobacco users (P < .01). Older patients were less likely to undergo reoperation (risk of reoperation increased with age). Other variables were not associated with increased complications. Conclusion. Patients who consumed alcohol or had been prescribed any amount of narcotic within 3 months preoperatively were at increased risk for complications. Patients who smoked were more likely to have a wound infection. Surgeons should be aware of these factors and counsel patients before surgery. Levels of Evidence: Level III: Retrospective comparative study

Download Full-text

Increased Risk of Wound Complications and Poor Healing following Laparotomy in HIV-Seropositive and AIDS Patients

Digestive Surgery ◽

10.1159/000018695 ◽

1999 ◽

Vol 16 (1) ◽

pp. 60-67 ◽

Cited By ~ 30

Author(s):

Peter A. Davis ◽

David J. Corless ◽

Brian G. Gazzard ◽

Christopher Wastell

Keyword(s):

Wound Complications ◽

Aids Patients ◽

Increased Risk ◽

Hiv Seropositive

Download Full-text

Wound Complications with Multiple Wrist Incisions in Distal Radius Reconstruction

Journal of Wrist Surgery ◽

10.1055/s-0041-1736605 ◽

2021 ◽

Author(s):

Joshua J. Meaike ◽

Christian Athens ◽

Nicole Sgromolo ◽

Alexander Y. Shin ◽

Peter C. Rhee

Keyword(s):

Wound Healing ◽

Soft Tissue ◽

Surgical Management ◽

Distal Radius ◽

High Energy ◽

Distal Radius Fractures ◽

Wound Complications ◽

Radius Fractures ◽

Increased Risk ◽

Delayed Healing

Abstract Background Placement and spacing of skin incisions are important for maintaining soft tissue perfusion and viability, particularly in the setting of local trauma. Question/Purpose The aim of this article is to determine if multiple skin incisions in the surgical management of distal radius fractures result in an increased risk of postoperative wound complications, particularly in the setting of high-energy mechanisms of injury with substantial initial displacement and associated soft-tissue insult that require multiple incisions for distal radius reconstruction. Patients and Methods A multicenter, retrospective chart review was performed for all adult patients who underwent open reduction, internal fixation of a closed distal radius fracture with multiple (≥2) hand, and wrist incisions with minimum follow-up of 6 weeks. Primary outcome measures included wound healing complications such as partial or complete skin necrosis, dehiscence, delayed healing, and superficial or deep infections. Results For 118 wrists, a total of 305 incisions were utilized, averaging 2.6 incisions per patient (range: 2–6) with the flexor carpi radialis and dorsal distal radius approaches occurring in 86 and 78% of cases, respectively. One patient was identified as having a pyogenic granuloma along an incision. However, two patients were identified as having wound concerns, including fracture blisters (n = 1) and wound margin epidermolysis (n = 1) along the incision. There were no cases of skin bridge necrosis, delayed healing, wound dehiscence, or infection. Conclusions There is no increased risk of wound healing complications with the use of multiple skin incisions (≥2) in the surgical management of distal radius fractures, afforded by the abundant and robust angiosomes around the wrist. Surgeons should have the confidence to utilize the necessary number of skin incisions to effectively reconstruct distal radius fractures.

Download Full-text

Tourniquet Use in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1681035 ◽

2019 ◽

Vol 32 (08) ◽

pp. 719-729 ◽

Cited By ~ 8

Author(s):

Jaymeson R. Arthur ◽

Mark J. Spangehl

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Wound Complications ◽

Evidence Based ◽

Increased Risk ◽

Negative Effect ◽

Total Knee ◽

Controversial Topic ◽

Antibiotic Delivery

AbstractTourniquet use in total knee arthroplasty has become a controversial topic. There are several benefits of its use including improved visualization, decreased blood loss, shorter operative times, and improved antibiotic delivery. Conversely, there are several significant downsides associated with tourniquet use including postoperative pain, neuromuscular injuries, wound complications, reperfusion injury, increased risk of thrombosis, patellar tracking issues, delayed rehabilitation including decreased postoperative range of motion, and its negative effect on patients with vascular disease. However, objectively, the literature does not definitively push us toward or away from the use of a tourniquet. Furthermore, several alternatives have been developed to help mitigate some of the adverse effects associated with its use. This article summarizes the evidence for and against tourniquet use and provides an evidence-based approach to help guide surgeons in their own practice.

Download Full-text

Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1479-0 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 4

Author(s):

Bo Wang ◽

Yang Zhao ◽

Qian Wang ◽

Bin Hu ◽

Liang Sun ◽

...

Keyword(s):

Minimally Invasive ◽

Functional Outcomes ◽

Plate Osteosynthesis ◽

Meta Analysis ◽

Deep Infection ◽

Tibial Fractures ◽

Low Risk ◽

Wound Complications ◽

Distal Tibial Fractures ◽

Randomized Controlled

Abstract Background The treatment for distal tibial fractures remains controversial to date. Minimally invasive percutaneous plate osteosynthesis (MIPPO) and intramedullary nailing (IMN) are well-accepted and effective methods for distal tibial fractures, but these methods were associated with complications. This study aimed to assess and compare the clinical and functional outcomes in patients with distal tibial fractures treated with MIPPO or IMN. Methods We systematically reviewed randomized controlled trials (RCTs) that compared MIPPO with IMN in patients with distal tibial fractures from inception till 15 August 2019. Also, quantitative summaries of time to reunion, rate of complications, and functional outcomes were evaluated. Results The pooled results suggested that patients in the MIPPO group had a longer time to reunion with a mean difference of 1.21 weeks [P = 0.02; 95% confidence interval (CI) 0.16–2.26)] than those in the IMN group. The overall union complications and deep infection between IMN and MIPPO were similar (P > 0.05). IMN had a significantly low risk of wound complications [risk ratio (RR) = 0.51, P = 0.00, 95% CI 0.34–0.77)]. The pooled functional outcomes of the two groups remained controversial by different evaluating scores. Conclusions Compared to MIPPO, IMN had a significantly low risk of wound complications and associated with limited time for reunion. Although the pooled functional outcomes of the two groups were controversial due to different evaluating scores, IMN was the preferred surgical technique than MIPPO for treating distal tibial fractures.

Download Full-text