Orthopaedic fracture site and wound healing risk among end-stage renal disease patients undergoing open reduction internal fixation: A database analysis

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-02-14 DOI:10.1016/j.jcot.2025.102946

Gabriel Hanna , Eric H. Tischler , Paul G. Mastrokostas , Matthew J. Mesimer , Eli Bryk , Paul S. Pipitone

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Abstract

Introduction

The aims of this study are to 1) identify incidence rate of fracture occurrence among end-stage renal disease (ESRD) patients requiring open reduction internal fixation (ORIF) stratified by anatomic site and 2) assess the risk of perioperative wound complications among ESRD fracture patients requiring ORIF compared to non-ESRD patients.

Materials and methods

This retrospective cohort study utilized the Nationwide Inpatient Sample database, covering the period from January 2002 to December 2014, to examine patients over 18 years of age who underwent ORIF for extremity fractures in the United States. Two-sample Z-tests were employed to assess differences in patient demographics, comorbidities, and anatomical fracture sites between ESRD and non-ESRD cohorts. Additionally, multivariate logistic regression was used to examine differences in specific wound complications between these cohorts, and ANOVA tests assessed the effect of dialysis modality on wound complication risk.

Results

A total of 867,378 patients undergoing ORIF, with 7055 (0.8 %) reported ESRD. ESRD patients had a significantly higher incidence of femur fractures compared to those without ESRD (61.9 % vs. 42.1 %, p < 0.05). Furthermore, ESRD patients had a 1.55, 2.14, and 2.57 times increased odds of wound complication (p = 0.001), wound dehiscence (p = 0.003), and non-healing wound (p = 0.007) compared to patients without ESRD, respectively. No significant differences were found in the impact of dialysis modality on overall wound complication, wound dehiscence, non-healing wounds, seroma, and wound infection rates (p > 0.05 for all).

Conclusions

ESRD patients are predisposed to more frequent fractures, particularly of the femur, than those without ESRD. Furthermore, it underscores the increased incidence of perioperative wound complications, such as infections and delayed healing, in patients with ESRD undergoing ORIF.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.