Abstract
Macro- and micronutrients play important roles in the biological wound-healing pathway. Although deficiencies may potentially affect orthopaedic trauma patient outcomes, data on nutritional deficiencies in orthopaedic trauma patients remain limited in the literature. The purpose of this study was to (1) evaluate the prevalence of macro- and micronutrient deficiencies in orthopaedic trauma patients with lower extremity fractures and (2) evaluate the impact of such deficiencies on surgical site complications. This retrospective study identified 867 patients with lower extremity fractures treated with surgical fixation from 2019 to 2020. Data recorded included albumin, prealbumin, protein, vitamins A/C/D, magnesium, phosphorus, transferrin and zinc, as well as wound complications. Nutritional deficiencies were found for prealbumin, albumin and transferrin at 50.5%, 23.4% and 48.5%, respectively. Furthermore, a high prevalence of micronutrient deficiencies (vitamin A, 35.4%; vitamin C, 54.4%; vitamin D, 75.4%; and zinc, 56.5%) was observed. We also recorded a statistically significant difference in wound complications in patients who were deficient in prealbumin (21.6% vs. 6.6%, p = 0.0142) and vitamin C (56.8% vs. 28.6%, p = 0.0236). Our study outlines the prevalence of nutritional deficiencies in an orthopaedic trauma population and identifies areas for possible targeted supplementation to decrease wound complications.
Highlights
The important role of nutrition in wound healing has been well documented in the literature, with macro- and micronutrients considered vital at every step of the wound healing pathway [1,2,3]
This study is a retrospective database analysis of orthopaedic trauma patients undergoing surgical fixation of their lower extremity fractures treated at a university-based level 1 trauma center between the years of 2019 and 2020
We found that 21.6% of fractures with a prealbumin deficiency had a wound complication, compared to 6.6% of those with normal prealbumin levels (p = 0.0142)
Summary
The important role of nutrition in wound healing has been well documented in the literature, with macro- and micronutrients considered vital at every step of the wound healing pathway [1,2,3]. Malnutrition is a known contributor to poor clinical outcomes, from increased morbidity and mortality to wound and surgical complications [6,7]. There is much interest in evaluating the role of nutrition in orthopaedic trauma patients, a vulnerable population sensitive to the effects of malnutrition. Previous literature has demonstrated that malnutrition, as defined by hypoalbuminemia, is common in the orthopaedic trauma population [8]. These authors recorded hypoalbuminemia and obesity as predictors of wound complications.
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