Factors Associated With Wound- and Implant-Related Complications After Surgical Treatment of Ankle Fractures

Diederik P J Smeeing; Jan P Briet; Charlotte S van Kessel; Michiel M Segers; Egbert J Verleisdonk; Luke P H Leenen; Roderick M Houwert; Falco Hietbrink

doi:10.1053/j.jfas.2018.03.050

Factors Associated With Wound- and Implant-Related Complications After Surgical Treatment of Ankle Fractures

J Foot Ankle Surg. 2018 Sep-Oct;57(5):942-947. doi: 10.1053/j.jfas.2018.03.050. Epub 2018 Jul 10.

Authors

Diederik P J Smeeing¹, Jan P Briet², Charlotte S van Kessel³, Michiel M Segers⁴, Egbert J Verleisdonk⁵, Luke P H Leenen⁶, Roderick M Houwert⁷, Falco Hietbrink⁸

Affiliations

¹ Surgical Resident, Traumacenter Utrecht, Utrecht, The Netherlands; Surgical Resident, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: diederiksmeeing@hotmail.com.
² Surgical Resident, Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
³ Surgical Resident, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
⁴ Trauma Surgeon, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
⁵ Trauma Surgeon, Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
⁶ Professor in Trauma Surgery, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁷ Trauma Surgeon, Traumacenter Utrecht, Utrecht, The Netherlands; Trauma Surgeon, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
⁸ Trauma Surgeon, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

PMID: 30005967
DOI: 10.1053/j.jfas.2018.03.050

Abstract

We have described the epidemiology of complications after surgical treatment of ankle fractures and assessed which factors are associated with the most frequent complications. We conducted a retrospective cohort study at 2 level 2 and 1 level 1 trauma center in a single trauma region in the Netherlands. The study variables were collected from the electronic medical patient records; all ankle fractures were classified using the Lauge-Hansen classification, and the complications were recorded. A total of 989 patients were included from 3 hospitals, with 173 complications in 156 patients (15.8%). The most frequent complication was wound related, occurring in 101 patients (10.2%). Implant-related complications occurred in 44 patients (4.4%). Other complications, such as cast pressure spots, posttraumatic dystrophy, nonunion, impingement, and pneumonia occurred in 28 patients (2.8%). The 2 most important complications were further analyzed for risk factors. Multivariate analysis showed the risk factors for wound-related complications were advanced age, increased American Society of Anesthesiologists classification, smoking, right side symptomatic, open fracture, and initial external fixation. Most implant-related complications were caused by malreduction (n = 22) or untreated syndesmotic injury (n = 19). Malreduction was associated with supination eversion fractures (p = .059), and untreated syndesmotic injury occurred more often with pronation external rotation fractures (p < .001). The most frequent complications after ankle fracture surgery were wound- and implant-related complications. Postoperative wound-related complications were multifactorial and dependent on a combination of trauma-, patient-, and treatment-related factors. In contrast, implant-related complications resulted from the interaction between the fracture type and subsequent surgical treatment.

Keywords: implant failure; infection; retrospective cohort; surgery; trauma.

MeSH terms

Adult
Aged
Ankle Fractures / etiology
Ankle Fractures / surgery*
Female
Fracture Fixation, Internal / adverse effects*
Humans
Male
Middle Aged
Netherlands
Postoperative Complications / diagnosis
Postoperative Complications / epidemiology*
Retrospective Studies
Risk Factors
Trauma Centers