Toro-Aguilera et al identified risk factors for infection associated with fixation of a distal tibia fracture. These can help guide patient management. The authors are from Hospital de la Santa Creu i Saint Pau in Barcelona, Spain.
Patient selection: distal tibia fracture requiring open reduction and internal fixation (ORIF)
These fractures have a high complication rate with high risk of infection
Factors with high p values for infection
(1) external fixation followed by open reduction and internal fixation (ORIF)
(2) use of corticosteroids
(3) open fracture
(4) fracture complexity
Risk factors for infection:
(1) older age
(2) antero-lateral plate
(3) splinting with short time to ORIF
Surgical wound dehiscence was associated with a high rate of infection.
Recommendations:
(1) use screws only if possible. If a plate is required, then chose antero-medial plates rather than antero-lateral plates if possible.
(2) use a longer waiting time prior to ORIF if possible
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