Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial

TY - JOUR

T1 - Wound complications after ankle surgery. Does compression treatment work?

T2 - A randomized, controlled trial

AU - Winge, Rikke

AU - Ryge, Camilla

AU - Bayer, Lasse

AU - Klausen, Tobias Wirenfeldt

AU - Gottlieb, Hans

PY - 2018

Y1 - 2018

N2 - Purpose: Infection rates following ankle fractures are as high as 19% in selected material and is the most common complication following this type of surgery, with potential catastrophic consequences. The purpose of this study was to test a regime of intermittent pneumatic compression, a compression bandage and a compression stocking and its effect on the rate of wound complications. The hypothesis was that compression could lower the infection rate from 20 to 5%. Methods: We performed a randomized, controlled, non-blinded trial, including 153 adult patients with unstable ankle fractures. Patients were randomized to either compression (N = 82) or elevation (N = 71). Patients with open fracture, DVT, pulmonary embolism, dementia, no pedal pulse, or no Danish address were excluded. Primary endpoint was infection. Secondary endpoints were necrosis and wound dehiscence. Results: After 2 weeks, 1.4% (0.0;7.6) in the compression group had infection compared to 4.6% (1.0;12.9) in the control group, p = 0.35. The rate of necrosis after 2 weeks was 7.0% (95% CI 2.3;15.7) in the compression group compared with 26.2% (95% CI 16.0;38.5) in the elevation group, p = 0.004. No difference was shown regarding wound dehiscence. Conclusion: Based on this study, we cannot conclude if compression therapy prevents infection or not. This is mainly due to under-powering of the study. The effect on necrosis was in favor of compression, but the trial was not powered to show a difference regarding this endpoints and the result is thus hypothesis generating. Further research is needed before a thorough recommendation on the use of compression treatment that can be made.

AB - Purpose: Infection rates following ankle fractures are as high as 19% in selected material and is the most common complication following this type of surgery, with potential catastrophic consequences. The purpose of this study was to test a regime of intermittent pneumatic compression, a compression bandage and a compression stocking and its effect on the rate of wound complications. The hypothesis was that compression could lower the infection rate from 20 to 5%. Methods: We performed a randomized, controlled, non-blinded trial, including 153 adult patients with unstable ankle fractures. Patients were randomized to either compression (N = 82) or elevation (N = 71). Patients with open fracture, DVT, pulmonary embolism, dementia, no pedal pulse, or no Danish address were excluded. Primary endpoint was infection. Secondary endpoints were necrosis and wound dehiscence. Results: After 2 weeks, 1.4% (0.0;7.6) in the compression group had infection compared to 4.6% (1.0;12.9) in the control group, p = 0.35. The rate of necrosis after 2 weeks was 7.0% (95% CI 2.3;15.7) in the compression group compared with 26.2% (95% CI 16.0;38.5) in the elevation group, p = 0.004. No difference was shown regarding wound dehiscence. Conclusion: Based on this study, we cannot conclude if compression therapy prevents infection or not. This is mainly due to under-powering of the study. The effect on necrosis was in favor of compression, but the trial was not powered to show a difference regarding this endpoints and the result is thus hypothesis generating. Further research is needed before a thorough recommendation on the use of compression treatment that can be made.

KW - Ankle fracture

KW - Compression treatment

KW - Necrosis

KW - Surgical site infection

KW - Trauma

KW - Wound complications

U2 - 10.1007/s00068-017-0892-5

DO - 10.1007/s00068-017-0892-5

M3 - Journal article

C2 - 29374780

AN - SCOPUS:85041098788

SN - 1863-9933

VL - 44

SP - 947

EP - 956

JO - European Journal of Trauma and Emergency Surgery

JF - European Journal of Trauma and Emergency Surgery

IS - 6

ER -