title: Risk factors for wound complications after ankle fracture surgery.
abstract: BACKGROUND
  The overall rate of complications after ankle fracture fixation varies between 5% and 40% depending on the population investigated, and wound complications have been reported to occur in 1.4% to 18.8% of patients. Large studies have focused on complications in terms of readmission, but few studies have examined risk factors for wound-related issues in the outpatient setting in a large number of patients. A review was performed to identify risk factors for wound complications tracked in the hospital and outpatient setting.
  
  
  METHODS
  Four hundred and seventy-eight patients underwent open reduction and internal fixation of an ankle fracture between 2003 and 2010 by a single surgeon at a single institution. Demographic characteristics, time to surgery, comorbidities, and postoperative care were tracked. Wound complications were defined as those requiring dressing care and oral antibiotics or requiring further surgical treatment.
  
  
  RESULTS
  Of the 478 patients who were followed, six (1.25%) had wounds requiring surgical debridement. Fourteen patients (2.9%) required further dressing care or a course of oral antibiotics. There were significant associations between wound complications and a history of diabetes (p < 0.001), peripheral neuropathy (p = 0.003), wound-compromising medications (p = 0.011), open fractures (p = 0.05), and postoperative noncompliance (p = 0.027). There was a significant difference in age between patients with and without wound complications (p = 0.045). We did not identify a relationship between time to surgery and complications.
  
  
  CONCLUSIONS
  These results highlight the difficulty of treating medically complex and noncompliant patient populations. With careful preoperative monitoring of swelling, time to surgery does not affect wound outcome. The failure of the patient to adhere to postoperative instructions should be a concern to the treating surgeon.
authors.affiliation: Department of Orthopedics, Thomas Jefferson University Hospital, Curtis Building #801, 1015 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Miller
authors.forename: Andrew
authors.initials: A
authors.lastname: Margules
authors.forename: Steven M
authors.initials: SM
authors.lastname: Raikin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011859:Radiography; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents