Abstract
Purpose
Surgical wound healing failure is the most common complication of malleolar fracture surgery, and appropriate treatment is important to prevent surgical site infection (SSI). This study aimed to determine the incidence of wound healing failure and deep surgical site infection under strict standardized surgical wound management after malleolar fracture surgery.
Methods
Sixty-two patients who underwent surgery for malleolar fracture (AO/OTA classification 44) were reviewed. Strict assessment and surgical intervention were performed even for trivial failure in all wound healing failure cases. The exclusion criteria were open wound, tibial diaphysis fracture, and follow-up < 6 months. Surgical wound healing failure, deep SSI, and posterior fixation status were evaluated in the 42 patients (44A, n = 5; 44B, n = 30; 44C, n = 7) finally included in the study. Patients with a 44B fracture were divided into a B1/B2 group (n = 10) and a B3 group (n = 20) for subgroup analysis to clarify the relationship between severity of malleolar fracture and incidence of surgical wound healing failure.
Results
The incidence of surgical wound healing failure was 19%, but there were no deep SSI. Two of 6 patients who underwent internal fixation for posterior malleolar fragments were complicated with wound failure. Surgical wound healing failure incidence was higher in the B3 group than in the B1/B2 group (30% vs 10%, p = 0.37).
Conclusions
More cases of wound healing failure and less deep SSI were detected in this study compared with previous studies. Strict standardized surgical wound management could help to avoid SSI after malleolar fracture surgery.