Risk factors associated with surgical site infection after internal fixation of ballistic diaphyseal fractures.
Recommended Citation
Weaver MJ, Khan U, Puri S, Lamiha S, Swanson K, Rababa I, Olson A, and Best B. Risk factors associated with surgical site infection after internal fixation of ballistic diaphyseal fractures. Injury 2025; 56(6):112302.
Document Type
Article
Publication Date
6-1-2025
Publication Title
Injury
Abstract
OBJECTIVES: Management of civilian gunshot wound (GSW) fractures is controversial, with limited data on infection risk and controversy regarding treatment. While lower-energy GSWs are considered lower risk than other open fractures, complication rates remain high. This study aimed to identify risk factors for infection in operatively treated ballistic fractures.
METHODS: After institutional review board approval, we identified 2136 GSW-related fractures from 01/01/2012 to 12/31/2021 at our level one trauma center. After excluding articular, hand, foot, injuries through viscera and pre-existing infections, 110 patients with 125 long bone fractures were retrospectively reviewed. The primary outcome was infection requiring reoperation. Statistical analysis included Mann-Whitney U, T-tests, Pearson's Chi-square, ROC analysis, and Youden's index.
RESULTS: Sixteen patients (14.5 %) developed infections requiring reoperation. The cohort had a mean age of 30 years, 90 % male, BMI 27.7 ± 7.2 kg/m², Charlson comorbidity index < 1, and 37 % smokers. Increased infection risk was associated with admission glucose (p < 0.001) and length of stay (p < 0.001). Admission glucose >156 mg/dL increased odds of infection sixfold (OR 6.1, 95 % CI 2.0-19.0), while a hospital stay >10 days increased odds of infection twentyfold (OR 21.1, 95 % CI 5.3-82.7). Transfusion (p = 0.004), abdominal (p = 0.007), and chest trauma (p = 0.010) also correlated with infection risk. No significant associations were found with nicotine use, Charlson comorbidity index, or BMI.
CONCLUSIONS: Operatively treated long bone injuries had a 14.5 % infection rate. Elevated admission glucose and prolonged hospital stay significantly increased infection risk, particularly in polytrauma patients. Identifying high-risk patients, promoting early mobilization, and ensuring glycemic control may help reduce infections. Further research is needed to develop targeted prevention strategies.
LEVEL OF EVIDENCE: 3 (Retrospective Comparative Study).
Medical Subject Headings
Humans; Male; Female; Adult; Surgical Wound Infection; Risk Factors; Retrospective Studies; Fracture Fixation, Internal; Wounds, Gunshot; Reoperation; Length of Stay; Trauma Centers; Middle Aged; Young Adult; Diaphyses; Fractures, Bone
PubMed ID
40163958
Volume
56
Issue
6
First Page
112302
Last Page
112302
