Safety of Prepping the External Fixator In Situ During Staged Internal Fixation of Pilon Fractures: A Retrospective Comparative Cohort Study

Abstract

Objective: (1) To assess the rate of fracture-related infection (FRI) and unplanned reoperation of disinfecting and prepping in the external fixator (Ex-Fix) instrument during definitive open reduction and internal fixation (ORIF) of pilon fractures treated by a staged protocol and (2) to determine whether the amount of time from external fixation to ORIF influences the risk of FRI. Design: Retrospective cohort study. Setting: Level 1 academic trauma center. Patients: One hundred thirty-three patients who underwent operative treatment for pilon fracture between 2010 and 2020. Intervention: External fixation and ORIF with or without the Ex-Fix prepped in situ during definitive fixation. Main Outcome Measurements: FRI and unplanned reoperation rates. Results: 133 patients were enrolled, of which 47 (35.3%) had Ex-Fix elements prepped in situ. There was an overall infection rate of 23.3% and unplanned reoperation rate of 11.3%, and there was no significant difference in rates between the 2 cohorts. Patients with Ex-Fix elements prepped in situ who developed an FRI had a higher rate of MRSA and MSSA. Diabetes (P = 0.0019), open fracture (P = 0.0014), and longer (≥30 days) interval to ORIF (P = 0.0001) were associated with postoperative FRI. Conclusions: Prepping elements of the Ex-Fix in situ did not lead to an increase in rates of FRI or unplanned reoperation. Although diabetes and open fracture were associated with FRI risk, a stronger association was a longer interval of Ex-Fix utilization before definitive internal fixation, specifically 30 days or greater. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.