INFECTIONS IN PERIARTICULAR FRACTURES OF THE LOWER-EXTREMITY TREATED WITH TENSIONED WIRE HYBRID FIXATORS

Objectives: To observe the incidence and clinical presentation of infe ction in periarticular fractures of the tibia and femur treated with t ensioned wire external fixators, Design: Prospective cohort study. Set ting: Level One Trauma Center in urban community. Single surgeon, Pati ents: One hundred thirty-five patients with 145 fractures: seventy tib ial plateau, fifty-six pilon, and nineteen distal. femur. Five-year tr eatment period, 1991 to 1995. Main Outcome Measurements: The incidence of infection was evaluated. Results: Nineteen of 145 fractures (13 pe rcent) were complicated by infection, Infections presented as pin trac t inflammation requiring intravenous antibiotics (seven), deep infecti on requiring debridement and removal (five), septic arthritis (three), deep fracture infection (three), and necrotizing fasciitis (one). Con clusions: Infection is a common complication of juxtaarticular fractur es treated with tensioned wire fixators. Excellent: pin care is requir ed. Aggressive management of infections with intravenous antibiotics a nd debridement will resolve infections occurring in patients treated w ith tensioned wire fixators. Septic arthritis is associated with wires placed less than one centimeter from the subchondral bone. Deep infec tion is associated with insidious swelling and excessive proliferative callus. Wire infections increase with prolonged frame time.