Do Indomethacin or Radiation for Heterotopic Ossification Prophylaxis Increase the Rates of Infection or Wound Complications After Acetabular Fracture Surgery?
| Autor: | Jonathan H Quade, Adam M. Almaguer, Clay A. Spitler, Elie Ghanem, Kyle H. Cichos, Gerald McGwin |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Indomethacin Fractures Bone 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors medicine Humans Orthopedics and Sports Medicine In patient Retrospective Studies 030222 orthopedics business.industry Ossification Heterotopic Anti-Inflammatory Agents Non-Steroidal Trauma center Acetabular fracture Acetabulum 030208 emergency & critical care medicine Retrospective cohort study General Medicine Odds ratio medicine.disease Confidence interval Surgery Heterotopic ossification business Operative fixation |
| Zdroj: | Journal of Orthopaedic Trauma. 34:455-461 |
| ISSN: | 0890-5339 |
| DOI: | 10.1097/bot.0000000000001775 |
| Popis: | OBJECTIVES To compare the rates of infection and wound complications in patients undergoing operative fixation (ORIF) of acetabular fractures receiving heterotopic ossification (HO) prophylaxis using indomethacin or external beam radiation therapy (XRT) versus no prophylaxis. DESIGN Retrospective cohort. SETTING Level I trauma center. PATIENTS We reviewed 473 patients undergoing ORIF of acetabular fractures through posterior, combined, or extensile surgical approaches from 2012 to 2017, with a median follow-up of 13 months (0.5-77 months). MAIN OUTCOME MEASUREMENT Rates of infection and wound complications were stratified according to their HO prophylaxis method into three groups as indomethacin, XRT, and no prophylaxis. RESULTS Overall, 167 patients (35.3%) received indomethacin, 104 patients (22.0%) received postoperative XRT, and 202 patients (42.7%) received no prophylactic treatment. There was no difference between the 3 groups for the risk of surgical site infection (P = 0.280). The XRT group had a significantly increased risk of noninfectious wound complications (20.2%) compared with the indomethacin group (6.6%, P = 0.002) and the no prophylaxis group (5.0%, P < 0.0001). Multivariate analysis revealed XRT remained a significant risk factor for noninfectious wound complications compared with no prophylaxis (odds ratio 5.39; 95% confidence interval 2.37-12.22; P < 0.0001). CONCLUSIONS Although there is no difference between XRT, indomethacin, and no HO prophylaxis for the risk of surgical site infection, the use of XRT results in more than 5 times increased risk of noninfectious wound complications compared with no prophylaxis. This increased risk should be considered when contemplating XRT for HO prophylaxis in acetabular fracture patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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