Objective: 

To determine patient-specific and injury-specific factors that may predict infection and other adverse clinical results in the setting of tibial pilon fractures.

Design: 

Retrospective chart review.

Setting: 

Level 1 academic trauma center.

Patients: 

Two hundred forty-eight patients who underwent operative treatment for tibial pilon fractures between 2010 and 2020.

Intervention: 

External fixation and/or open reduction and internal fixation.

Main Outcome Measurements: 

Fracture-related infection rates and specific bacteriology, risk factors associated with development of a fracture-related infection, and predictors of adverse clinical results.

Results: 

Two hundred forty-eight patients were enrolled. There was an infection rate of 21%. The 3 most common pathogens cultured were methicillin-resistant Staphylococcus aureus (20.3%), Enterobacter cloacae (16.7%), and methicillin-resistant Staphylococcus aureus (15.5%). There was no significant difference in age, sex, race, body mass index, or smoking status between those who developed an infection and those who did not. Patients with diabetes mellitus (P = 0.0001), open fractures (P = 0.0043), and comminuted fractures (OTA/AO 43C2 and 43C3) (P = 0.0065) were more likely to develop a fracture-related infection. The presence of a polymicrobial infection was positively associated with adverse clinical results (P = 0.006). History of diabetes was also positively associated with adverse results (P = 0.019).

Conclusions: 

History of diabetes and severe fractures, such as those that were open or comminuted fractures, were positively associated with developing a fracture-related infection after the operative fixation of tibial pilon fractures. History of diabetes and presence of a polymicrobial infection were independently associated with adverse clinical results.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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手术治疗 Pilon 骨折时感染的危险因素和随后的不良临床结果

 客观的：

确定可预测胫骨柱骨折情况下感染和其他不良临床结果的患者特异性和损伤特异性因素。

 设计：

回顾性图表审查。

 环境：

一级学术创伤中心。

 患者：

2010 年至 2020 年间，有 248 名患者因胫骨柱骨折接受了手术治疗。

 干涉：

外固定和/或切开复位内固定。

主要结果测量：

骨折相关感染率和特定细菌学、与骨折相关感染发生相关的危险因素以及不良临床结果的预测因素。

 结果：

共招募了 248 名患者。感染率为21%。培养的 3 种最常见病原体是耐甲氧西林金黄色葡萄球菌（20.3%）、阴沟肠杆菌（16.7%）和耐甲氧西林金黄色葡萄球菌（15.5%）。感染者和未感染者之间的年龄、性别、种族、体重指数或吸烟状况没有显着差异。患有糖尿病 ( P = 0.0001)、开放性骨折 ( P = 0.0043) 和粉碎性骨折 (OTA/AO 43C2 和 43C3) ( P = 0.0065) 的患者更有可能发生骨折相关感染。多种微生物感染的存在与不良临床结果呈正相关（ P = 0.006）。糖尿病史也与不良结果呈正相关（ P = 0.019）。

 结论：

糖尿病史和严重骨折（例如开放性或粉碎性骨折）与胫骨柱骨折手术固定后发生骨折相关感染呈正相关。糖尿病史和多种微生物感染的存在与不良临床结果独立相关。

 证据级别：

预后 III 级。有关证据级别的完整描述，请参阅作者须知。