Infections in Periarticular Fractures of the Lower Extremity Treated with Tensioned Wire Hybrid Fixators

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Abstract
To observe the incidence and clinical presentation of infection in periarticular fractures of the tibia and femur treated with tensioned wire external fixators. Prospective cohort study. Level One Trauma Center in urban community. Single surgeon. One hundred thirty-five patients with 145 fractures: seventy tibial plateau, fifty-six pilon, and nineteen distal femur. Five-year treatment period, 1991 to 1995. The incidence of infection was evaluated. Nineteen of 145 fractures (13 percent) were complicated by infection. Infections presented as pin tract inflammation requiring intravenous antibiotics (seven), deep infection requiring debridement and removal (five), septic arthritis (three), deep fracture infection (three), and necrotizing fasciitis (one). Infection is a common complication of juxtaarticular fractures treated with tensioned wire fixators. Excellent pin care is required. Aggressive management of infections with intravenous antibiotics and debridement will resolve infections occurring in patients treated with tensioned wire fixators. Septic arthritis is associated with wires placed less than one centimeter from the subchondral bone. Deep infection is associated with insidious swelling and excessive proliferative callus. Wire infections increase with prolonged frame time.