Predictors of deep infection after distal femur fracture: a multicenter study.

Abstract

To identify potentially modifiable risk factors for deep surgical site infection after distal femur fracture. Multicenter retrospective cohort study. Ten Level-I trauma centers. Patients with OTA/AO 33A or C distal femur fractures (n = 1,107). Surgical fixation of distal femur fracture. The outcome of interest was deep surgical site infection. There was a 7% (79/1107) rate of deep surgical site infection. In the multivariate analysis, predictive factors included alcohol abuse (odds ratio [OR] = 2.36; 95% confidence interval [CI]: 1.17 - 4.46; p = 0.01), intra-articular injury (OR = 1.73; 95% CI: 1.01 - 3.00; p = 0.05), vascular injury (OR = 3.90; 95% CI: 1.63 - 8.61; p < 0.01), the use of topical antibiotics (OR = 0.50; 95% CI: 0.25 - 0.92; p = 0.03), and the duration of the surgery (OR = 1.15 per hour; 95% CI: 1.01 - 1.30; p = 0.04). There was a nonsignificant trend toward an association between infection and type III open fracture (OR = 1.73; 95% CI: 0.94 - 3.13; p = 0.07), and lateral approach (OR = 1.60; 95% CI: 0.95 - 2.69; p = 0.07). The most frequently cultured organisms were methicillin-resistant Staphylococcus aureus (22%), methicillin-sensitive Staphylococcus aureas (20%), and Enterobacter cloacae (11%). 7% of distal femur fractures developed deep surgical site infections. Alcohol abuse, intra-articular fracture, vascular injury, and increased surgical duration were risk factors, while the use of topical antibiotics was protective. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.