{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T03:52:18Z","timestamp":1775533938849,"version":"3.50.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T00:00:00Z","timestamp":1588723200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To identify comorbidities and injury characteristics associated with surgical site infection (SSI) following internal fixation of malleolar fractures in an urban level 1 trauma setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Level 1 trauma center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants:<\/jats:title>\n                    <jats:p>Seven-hundred seventy-six consecutive patients with operatively managed malleolar fractures from 2006 to 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention:<\/jats:title>\n                    <jats:p>Open reduction internal fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measurements:<\/jats:title>\n                    <jats:p>Superficial SSI (erythema and drainage treated with oral antibiotics and wound care) or deep SSI (treated with surgical debridement and antibiotics).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fifty-six (7.2%) patients developed SSI, with 17 (30%) of these being deep infections. An a-priori power analysis of n\u200a=\u200a325 (\u03b1=0.05, \u03b2=0.2) was tabulated for differences in univariate analysis. Univariate analysis identified categorical associations (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u200a&lt;\u200a.05) between SSI and diabetes mellitus, drug abuse, open fracture, and renal disease but not tobacco abuse, body mass index, or neuropathy. Multivariate logistic regression identified categorical associations between diabetes (OR\u200a=\u200a2.2, 95% CI: 1.1\u20134.3), drug abuse (OR\u200a=\u200a3.9, 95% CI: 1.2\u201312.7), open fracture (OR\u200a=\u200a4.1, 95% CI: 1.3\u201312.8), and renal disease (OR\u200a=\u200a2.7, 95% CI: 1.4\u20135.0) and any (superficial or deep) SSI. A separate multivariate logistic regression analysis found categorical associations between deep SSI requiring reoperation and diabetes (OR\u200a=\u200a4.4, 95% CI: 1.6\u201312.2) and open fracture (OR\u200a=\u200a4.1, 95% CI: 1.3\u201312.8). Furthermore, American society of anesthesiologists classification (ASA) Class 4 patients were (OR\u200a=\u200a9.2, 95% CI: 2.0\u201341.79) more likely to experience an SSI than ASA Class 1 patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Factors associated with SSI following malleolar fracture surgery in a single urban level 1 trauma center included diabetes, drug abuse, renal disease, and open fracture. The presence of diabetes or open type fractures were associated with deep SSI requiring reoperation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level 3 prognostic: retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/oi9.0000000000000077","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T17:02:31Z","timestamp":1615827751000},"page":"e077","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Factors associating with surgical site infection following operative management of malleolar fractures at an urban level 1 trauma center"],"prefix":"10.1097","volume":"3","author":[{"given":"Alexander S.","family":"Rascoe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael D.","family":"Kavanagh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan A.","family":"Audet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather A.","family":"Vallier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2020,6]]},"reference":[{"key":"R1-20260407","doi-asserted-by":"crossref","first-page":"539","DOI":"10.3109\/17453678709146395","article-title":"Epidemiology of ankle fractures in Rochester, Minnesota","volume":"58","author":"Daly","year":"1987","journal-title":"Acta Orthop Scand."},{"key":"R2-20260407","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: a review","volume":"37","author":"Court-Brown","year":"2006","journal-title":"Injury."},{"key":"R3-20260407","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1001\/jama.2016.14719","article-title":"Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults: a randomized clinical trial","volume":"316","author":"Willett","year":"2016","journal-title":"JAMA -."},{"key":"R4-20260407","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1097\/BOT.0b013e31824aec42","article-title":"Is surgical fixation for stress-positive unstable ankle fractures cost effective? 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