title: Predictors of Postoperative Wound Necrosis Following Primary Wound Closure of Open Ankle Fractures.
abstract: BACKGROUND
  Most open malleolar ankle fracture wounds can be closed primarily after meticulous debridement. However, the development of wound necrosis following operative treatment of open malleolar ankle fractures can have catastrophic consequences. The aim of this study was to identify risk factors predisposing to postoperative wound necrosis following primary wound closure of open malleolar ankle fractures.
  
  
  METHODS
  A total of 137 patients with open malleolar ankle fractures were identified. The open fracture wound was primarily closed in 110 of 137 (80%) patients, and postoperative wound necrosis occurred in 18 (16%) of these patients. These patients were compared to the open fracture patients without wound necrosis. Twenty possible risk factors for the development of wound necrosis were studied with logistic regression analysis.
  
  
  RESULTS
  The variables that were independently associated with an increased risk for postoperative wound necrosis included ASA class ≥2, Gustilo grade III open injury, and the use of pulsatile lavage at index surgery.
  
  
  CONCLUSIONS
  Our study showed that ASA class ≥2, Gustilo grade III open injury, and the use of pulsatile lavage at index surgery were the most important factors predisposing to postoperative wound necrosis following primary wound closure of open malleolar ankle fractures. The findings warrant a further study specifically comparing primary and delayed wound closure in patients with Gustilo grade III open malleolar ankle fractures and different ASA classes. Also, the role of pulsatile lavage should be re-evaluated.
  
  
  METHODS
  Level III, retrospective comparative series.
authors.affiliation: Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland mikko.ovaska@hus.fi.
authors.forename: Mikko T
authors.initials: MT
authors.lastname: Ovaska
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Madanat
authors.affiliation: Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tatu J
authors.initials: TJ
authors.lastname: Mäkinen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000145:classification / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000145:classification / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012189:Retrospective Studies; D012307:Risk Factors; D000072836:Surgical Wound / Q000473:pathology*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000473:pathology; D007507:Therapeutic Irrigation
keywords: ankle fracture; open fracture; trauma; wound closure; wound necrosis