足と足首の臨床研究

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Comparison of the Rate of Wound Infection Post Ankle Open Reduction and Internal Fixation: A Prospective Randomized Control Trial

Moniz S, Mccurdy D, Yates P, Seresti S and Albers CE

Method: A prospective study was conducted including 370 patients (mean age: 42, range 18-88 years) undergoing ORIF for ankle fractures. Wound closure was performed according to a standardized protocol (layered with vicryl and nylon), and dressings were applied via randomisation with with chlorhexidine 0.5% in alcohol 70% (n=185), or normal opsite^® dressing (n=185) and left covered for 14 days. Follow up was performed at two and six weeks in clinic with Southampton scoring sheet filled and normal dressing applied. Statisical analysis comprised Fisher’s exact test for comparison of binominal data, and multivariate logistic regression analyses with impaired wound healing or wound infection as the dependent outcome variable and type of dressing, age, gender, smoking and diabetes as independent variables.
Results: The mean age was 43 ± 18.3 years (range 18-88) with 254 females (139 vs. 115) and 116 males (46 vs. 70) recruited for the ordinary and alcohol groups respectively. At two weeks post-operatively the ordinary vs. alcohol dressings group had 24 patients (10 vs. 14 p=0.89) with impaired healing, 2 patients (0 vs. 2 p=0.995) with delayed healing and no patients with deep infections. At six weeks post-operatively 18 patients (9 vs. 9 p=0.97) had impaired healing, 11 patients (5 vs. 6 p=0.82) had delayed healing and 5 patients (3 vs. 2 p=0.73) had deep infections requiring further orthopaedic intervention.
Conclusions: There is no significant difference in wound outcome scores at two or six weeks between using an alcohol based or ordinary dressing for surgical management of closed ankle fractures.