Patients with diabetes mellitus suffer from up to three times more postoperative complications than non-diabetic patients. Especially postoperative infections are reported in the literature with a frequency between 1 and 8%. Documented complications in the literature are postoperative wound healing complications, infections, postoperative malalignment, posttraumatic arthritis in the long-term follow-up, and (septic) non-union. Despite the relatively simple surgical technique, this intervention is often associated with complications. Still, surgery is performed in most of the cases with open reduction and plate osteosynthesis. Plates, screws, Kirschner wires, and also external fixations are represented. įor surgical treatment of displaced ankle fractures, various implants are commonly used in daily practice. However, more frequently, they occur in patients with comorbidities such as diabetes mellitus, peripheral arterial disease, and osteoporosis. Trial registrationĪmong fractures treated by trauma surgeons, ankle fractures are the common injuries with an incidence of 187:100,000 people in the US population. Special care must be taken of risk factors like diabetes and smoking. Immediate revision surgery with aggressive debridement, microbiological diagnostics, antibiotic therapy, and use of a drain until osseous consolidation is reached with following removal of the implant in patients with implant-associated infections after ankle fracture and open reduction internal fixation lead to cure of infection and fair long-term outcome in all cases. The matched-pair group showed significantly better long-term outcome in mean regarding the Ankle Osteoarthritis Score (2.0 ± 1.2/13.9 ± 4.7) and AOFAS hindfoot score (96.7 ± 1.9/87.3 ± 3.4). Patients with implant-associated infections had significantly more risk factors than infection-free patients (1.1/0.33 p = .02 per patient). Cure of infection and clinical and radiographic osseous consolidation could be documented for all cases. Common comorbidities/risk factors were cardiovascular disease (28%), smoking (15%), and diabetes (18%). Microbiological specimen showed in 77% Staphylococcus aureus with following intravenous antibiotic treatment for 13.9 ± 3.1 days in mean. Most of the cases were Weber B fractures (38%) following an in-patient stay from 51 ± 4.3 days after primary treatment and 77 ± 10.0 days after secondary treatment in our hospital. Resultsįorty-four patients could be retrospectively evaluated (51% male, 49% women, mean age 46 ± 17 years). Moreover, present long-term outcome was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, the Ankle Osteoarthritis Score, and the Short Form 36 score and compared to a matched-pair infection-free patient cohort. Methodsĭata from patients of over 20 years of a level 1 trauma center and university hospital was retrospectively analyzed including age, gender, comorbidities, smoking status, fracture classification, number of revisions, length of in-patient stay due to fracture and infection, and results of microbiological specimen with the length of antibiotic treatment. Therefore, this study shows and evaluates a treatment algorithm in long- and short-term outcomes compared to infection-free patients. Little is known about postoperative treatment of implant-associated infections of the ankle. Despite the relatively simple operative technique, patients often suffer from postoperative complications. Ankle fractures are frequently occurring injuries.
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