Purpose
To establish and compare the incidence of 30-day postoperative infection in surgically
managed open and closed metacarpal and phalangeal fractures, and to determine whether
open fractures treated urgently had a lower incidence of postoperative infection.
Methods
We conducted a retrospective analysis of patient demographics, comorbidities, and
30-day infection rates of patients undergoing operative fixation of metacarpal, proximal,
or middle phalanx fractures from 2008 to 2015 using the American College of Surgeons’
National Surgical Quality Improvement Program database. A total of 3,506 patients
were identified and patient variables and infection incidence were compared between
open and closed injuries, as well as open injuries managed within 1 day of admission
and those treated on an elective basis or treated more than 1 day after admission.
Bivariate analysis was used to determine independent risk factors for postoperative
infection.
Results
Although 34.2% of open hand fractures were taken urgently to the operating room, the
diagnosis of open fractures along with nonurgent surgical treatment for open fractures
was associated with a low incidence of postoperative infection. In addition, smoking
was a risk factor for postoperative infection although anatomic location (phalanx
vs metacarpal) was not.
Conclusions
Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures
are not at greater risk for infection based on the diagnosis of open fracture alone.
In addition, patients with open fractures who are taken to the operating room more
than 1 day from presentation did not have a higher incidence of infection. Smoking
is associated with increased 30-day infection rates after surgery, and surgeons should
identify these patients for preoperative risk stratification, counseling, and postoperative
wound monitoring.
Type of study/level of evidence
Prognostic II.
Key words
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Article info
Publication history
Published online: June 13, 2018
Accepted:
April 27,
2018
Received:
August 19,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
