What Are the Risk Factors for Infection After Operative Treatment of Peritalar Fracture Dislocations?

Abstract

To assess the risk factors associated with deep infection after operative treatment of peritalar fracture dislocations. A retrospective study was performed to identify patients who had operative treatment of a peritalar fracture dislocation over an 11-year period (2008-2019). Level 1 trauma center. Patients were identified by review of all surgical billing that included open reduction of peritalar dislocation. Minimum follow-up for inclusion was 3 months or the outcome of interest. A total of 178 patients were identified, and 154 patients met inclusion criteria. The primary outcome was deep infection, defined as return to the operating room for debridement with positive cultures. A total of 19 (12.3%) patients developed a postoperative deep infection. The most common associated fractures were talus (47%), calcaneus (33%), and fibula (9%) fractures. The infected group was significantly older (47.2 vs. 39.5 years, P = 0.03). Patients undergoing operative management for peritalar fracture dislocations with current smoking were found to have significantly higher odds of postoperative deep infection (74 vs. 34%, adjusted odds ratio = 7.4, 95% confidence interval, 2.3-24.1, P = 0.001). There was a significantly higher risk of infection in patients with a Gustilo-Anderson type 3 open fracture (32 vs. 12%, adjusted odds ratio = 5.7, 95% confidence interval, 1.6-20.3, P = 0.007). The infected group had high rates of below knee amputation when compared with the group without infection (47 vs. 1%, P < 0.001). In our retrospective study, risk factors for infection after peritalar fracture dislocation included older age, smoking, and Gustilo-Anderson type 3 open fracture. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.