Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

Femke M. A. P. Claessen MD, Yvonne Braun MD, Wouter F. Leeuwen MD, George S. Dyer MD, Michel P. J. den Bekerom MD, David Ring MD, PhD

Abstract

Background

Surgical site infections are one of the more common major complications of elbow fracture surgery and can contribute to other adverse outcomes, prolonged hospital stays, and increased healthcare costs.

Questions/purposes

We asked: (1) What are the factors associated with a surgical site infection after elbow fracture surgery? (2) When taking the subset of closed elbow fractures only, what are the factors associated with a surgical site infection? (3) What are the common organisms isolated from an elbow infection after open treatment?

Methods

One thousand three hundred twenty adult patients underwent surgery for an elbow fracture between January 2002 and July 2014 and were included in our study. Forty-eight of 1320 patients (4%) had a surgical site infection develop. Thirty-four of 1113 patients with a closed fracture (3%) had a surgical site infection develop.

Results

For all elbow fractures, use of plate and screw fixation (adjusted odds ratio [OR]= 2.2; 95% CI, 1.0–4.5; p = 0.041) and use of external fixation before surgery (adjusted OR = 4.7; 95% CI, 1.1–21; p = 0.035) were associated with higher infection rates. When subset analysis was performed for closed fractures, only smoking (adjusted OR = 2.2; 95% CI, 1.1–4.5; p = 0.023) was associated with higher infection rates.was the most common bacteria cultured (59%).

Conclusions

The only modifiable risk factor for a surgical site infection after open reduction and internal fixation was cigarette smoking. Plate fixation and temporary external fixation are likely surrogates for more complex injuries, therefore no recommendations should be inferred from this association. Surgeons should counsel patients who smoke.

Level of Evidence

Level IV, prognostic study.

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