Abstract
BackgroundAnkle fractures are frequently occurring injuries. Despite the relatively simple operative technique, patients often suffer from postoperative complications. Little is known about postoperative treatment of implant-associated infections of the ankle. Therefore, this study shows and evaluates a treatment algorithm in long- and short-term outcomes compared to infection-free patients.MethodsData 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. 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.ResultsForty-four patients could be retrospectively evaluated (51% male, 49% women, mean age 46 ± 17 years). 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. Microbiological specimen showed in 77% Staphylococcus aureus with following intravenous antibiotic treatment for 13.9 ± 3.1 days in mean. Common comorbidities/risk factors were cardiovascular disease (28%), smoking (15%), and diabetes (18%). Cure of infection and clinical and radiographic osseous consolidation could be documented for all cases.Patients with implant-associated infections had significantly more risk factors than infection-free patients (1.1/0.33; p = .02 per patient). 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).ConclusionImmediate 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. Special care must be taken of risk factors like diabetes and smoking.Trial registration24/2008BO2
Highlights
Among fractures treated by trauma surgeons, ankle fractures are the common injuries with an incidence of 187:100,000 people in the US population
Besides the epidemiological data such as gender, age, comorbidities, smoking status, fracture classification, the number of revisions, and the length of in-patient stay due to fracture and infection management, we documented the results of microbiological swab with the length of antibiotic treatment
The outcome was evaluated with the Ankle Osteoarthritis Scale and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score [24, 25]
Summary
Among fractures treated by trauma surgeons, ankle fractures are the common injuries with an incidence of 187:100,000 people in the US population More frequently, they occur in patients with comorbidities such as diabetes mellitus, peripheral arterial disease, and osteoporosis [1,2,3]. Implant-associated postoperative infections are a rare complication after surgical treatment of ankle fractures in the past. The development of an implant-associated infection can be a potentially devastating complication following foot and ankle surgery This leads to a high number of revision surgeries after initial fracture stabilization and potential loss of function of the joint and quality of life in the long-term follow-up [9]. These are conservative treatment with local or systemic antibiotics, operative revision and change of the implant, or revision and leaving a drain in place until osseous consolidation [18,19,20]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
