title: Utility of Fresh Frozen Section Analysis in Foot and Ankle Surgery: A Pilot Study.
abstract: The use of intraoperative fresh frozen section (FFS) analysis to determine the presence of infection has been well reported in orthopedic studies. Specifically, the number of polymorphonuclear leukocytes per high-power field has been used to diagnose total joint arthroplasty-related infection. Less commonly, reconstructive surgeons have extended the use of FFS analysis for intraoperative evaluation when suspicion of deep infection with or without hardware is high. The purpose of the present study was to retrospectively review the data from 11 patients undergoing foot and ankle reconstruction in the setting of possible deep infection and determine the usefulness of FFS analysis. A retrospective review of the medical records of patients who had undergone reconstructive foot and ankle revision surgery with intraoperative FFS analysis and tissue/swab cultures available was performed. A positive FFS was defined as >5 polymorphonuclear leukocytes per high-power field. A positive frozen section was associated with a positive tissue culture 4 of 7 times (57%). The sensitivity and specificity of FFS analysis for infection was 80% and 50%, respectively. The positive and negative predictive value of the FFS result was 57.1% and 75%, respectively. In conclusion, FFS analysis and intraoperative cultures correlated only 57% of the time in the present series. This test had moderate sensitivity for detecting infection at 80%, but the specificity was poor (50%). More research is needed to further evaluate the role of FFS analysis in foot and ankle surgery.
authors.affiliation: Second-Year Resident Physician, Podiatric Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: monacosj2@upmc.edu.
authors.forename: Spencer J
authors.initials: SJ
authors.lastname: Monaco
authors.affiliation: Clinical Instructor of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Podiatric Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Jeffery M
authors.initials: JM
authors.lastname: Manway
authors.affiliation: Assistant Professor of Orthopaedic Surgery, Division of Foot and Ankle Surgery, and Residency Director, Podiatric Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Burns
mesh_terms: D000328:Adult; D000842:Ankle / Q000601:surgery; D001178:Arthroplasty / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000601:surgery; D005629:Frozen Sections / Q000706:statistics & numerical data*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: arthroplasty-related infection; fresh frozen section; polymorphonuclear leukocytes