CME OnDemand: 2022 AOFAS Annual Meeting-Is It Safe to Prep the External Fixator In Situ During Staged ORIF of Pilon Fractures? A Retrospective Comparative Cohort Study

Is It Safe to Prep the External Fixator In Situ During Staged ORIF of Pilon Fractures? A Retrospective Comparative Cohort Study

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The study aimed to compare the risk of fracture-related infection (FRI) and unplanned reoperation after staged open reduction and internal fixation (ORIF) of pilon fractures in cases where the external fixator (Ex-Fix) was prepped into the surgical field versus cases where the Ex-Fix was completely removed prior to ORIF. A retrospective comparative cohort analysis was conducted on 133 patients who underwent staged ORIF for pilon fractures at a single-academic level 1 trauma center over a 10-year period. The patients were divided into two groups based on whether they had at least one element of the Ex-Fix prepped into the surgical field during ORIF or if the Ex-Fix was entirely removed prior to ORIF. <br /><br />The study found that prepping in elements of the Ex-Fix during staged ORIF treatment for pilon fractures did not significantly increase the rates of FRI or unplanned reoperation. The two cohorts had similar rates of infection and unplanned reoperation, with 23.3% of patients with the Ex-Fix removed and 23.4% of patients with the Ex-Fix prepped developing FRI. The subset of patients who developed FRI after prepping in the Ex-Fix had a higher prevalence of infection with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). The demographics, clinical characteristics, and injury characteristics between the two groups were similar. The post-operative outcomes were also similar between the two groups. <br /><br />In conclusion, prepping in elements of the Ex-Fix during staged ORIF treatment of pilon fractures did not lead to a significant increase in rates of FRI or unplanned reoperation. The study suggests that retaining the Ex-Fix in situ during the ORIF procedure is a safe practice. However, it is important to note that this study was retrospective, and further research may be needed to validate these findings.

Asset Subtitle

Teja Yeramosu, Amanda Hayes, Porter Young, David Cinats, Stephen Kates, Tejas J. Patel, MD, Paul W. Perdue

Keywords

fracture-related infection

unplanned reoperation

staged open reduction and internal fixation

pilon fractures

external fixator

surgical field

retrospective comparative cohort analysis

infection rates

methicillin-resistant Staphylococcus aureus

methicillin-sensitive Staphylococcus aureus