Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial
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...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2018-12, Vol.44 (6), p.947-956 |
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| container_title | European journal of trauma and emergency surgery (Munich : 2007) |
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| creator | Winge, Rikke Ryge, Camilla Bayer, Lasse Klausen, Tobias Wirenfeldt Gottlieb, Hans |
| description | 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. |
| doi_str_mv | 10.1007/s00068-017-0892-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1993009740</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1993475806</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-16d0a6e59e5357105a5cb0e40d5fca7432661f389eddc3473ab016615e2e55633</originalsourceid><addsrcrecordid>eNp10U1LxDAQBuAgit8_wIsEvHiwOmmapD2J-A2CF8VjyDZTrbbJmrSI_nqzuyoieEpInpmEeQnZYXDIANRRBABZZsBUBmWVZ2KJrLNS8qyqCrb8s-d8jWzE-JwwSJGvkrW84qpQJayTpwc_Oktr30-7tjZD612kphkwUONeOqRxDI8Y3g_pmcc4dwFjTIwOAc3Qoxvomw8vx_SEBuOs79sPtAdJuiH4rkObYGu6LbLSmC7i9te6Se4vzu9Or7Kb28vr05ObrOYqHzImLRiJokLBhWIgjKgngAVY0dRGFTyXkjW8rNDamheKmwmwdCQwRyEk55tkf9F3GvzriHHQfRtr7Drj0I9RszQPgEoVkOjeH_rsx-DS7-aqUKIEmRRbqDr4GAM2ehra3oR3zUDPYtCLGHSKQc9i0CLV7H51Hic92p-K77knkC9ATFcuDfjX0_92_QTh_JKh</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1993475806</pqid></control><display><type>article</type><title>Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Winge, Rikke ; Ryge, Camilla ; Bayer, Lasse ; Klausen, Tobias Wirenfeldt ; Gottlieb, Hans</creator><creatorcontrib>Winge, Rikke ; Ryge, Camilla ; Bayer, Lasse ; Klausen, Tobias Wirenfeldt ; Gottlieb, Hans</creatorcontrib><description>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.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-017-0892-5</identifier><identifier>PMID: 29374780</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ankle ; Ankle Fractures - surgery ; Compression Bandages ; Compression therapy ; Critical Care Medicine ; Dementia ; Denmark ; Emergency Medicine ; Evidence-based medicine ; Female ; Fracture Fixation, Internal ; Fractures ; Gangrene ; Humans ; Hypotheses ; Infections ; Intensive ; Intermittent Pneumatic Compression Devices ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Posture ; Pressure ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Surgical site infections ; Surgical Wound Infection - prevention & control ; Traumatic Surgery ; Treatment Outcome ; Young Adult</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2018-12, Vol.44 (6), p.947-956</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>European Journal of Trauma and Emergency Surgery is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-16d0a6e59e5357105a5cb0e40d5fca7432661f389eddc3473ab016615e2e55633</citedby><cites>FETCH-LOGICAL-c372t-16d0a6e59e5357105a5cb0e40d5fca7432661f389eddc3473ab016615e2e55633</cites><orcidid>0000-0002-0501-8192</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-017-0892-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-017-0892-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29374780$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Winge, Rikke</creatorcontrib><creatorcontrib>Ryge, Camilla</creatorcontrib><creatorcontrib>Bayer, Lasse</creatorcontrib><creatorcontrib>Klausen, Tobias Wirenfeldt</creatorcontrib><creatorcontrib>Gottlieb, Hans</creatorcontrib><title>Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ankle</subject><subject>Ankle Fractures - surgery</subject><subject>Compression Bandages</subject><subject>Compression therapy</subject><subject>Critical Care Medicine</subject><subject>Dementia</subject><subject>Denmark</subject><subject>Emergency Medicine</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Fracture Fixation, Internal</subject><subject>Fractures</subject><subject>Gangrene</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Infections</subject><subject>Intensive</subject><subject>Intermittent Pneumatic Compression Devices</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Posture</subject><subject>Pressure</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Surgical site infections</subject><subject>Surgical Wound Infection - prevention & control</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp10U1LxDAQBuAgit8_wIsEvHiwOmmapD2J-A2CF8VjyDZTrbbJmrSI_nqzuyoieEpInpmEeQnZYXDIANRRBABZZsBUBmWVZ2KJrLNS8qyqCrb8s-d8jWzE-JwwSJGvkrW84qpQJayTpwc_Oktr30-7tjZD612kphkwUONeOqRxDI8Y3g_pmcc4dwFjTIwOAc3Qoxvomw8vx_SEBuOs79sPtAdJuiH4rkObYGu6LbLSmC7i9te6Se4vzu9Or7Kb28vr05ObrOYqHzImLRiJokLBhWIgjKgngAVY0dRGFTyXkjW8rNDamheKmwmwdCQwRyEk55tkf9F3GvzriHHQfRtr7Drj0I9RszQPgEoVkOjeH_rsx-DS7-aqUKIEmRRbqDr4GAM2ehra3oR3zUDPYtCLGHSKQc9i0CLV7H51Hic92p-K77knkC9ATFcuDfjX0_92_QTh_JKh</recordid><startdate>20181201</startdate><enddate>20181201</enddate><creator>Winge, Rikke</creator><creator>Ryge, Camilla</creator><creator>Bayer, Lasse</creator><creator>Klausen, Tobias Wirenfeldt</creator><creator>Gottlieb, Hans</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0501-8192</orcidid></search><sort><creationdate>20181201</creationdate><title>Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial</title><author>Winge, Rikke ; Ryge, Camilla ; Bayer, Lasse ; Klausen, Tobias Wirenfeldt ; Gottlieb, Hans</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-16d0a6e59e5357105a5cb0e40d5fca7432661f389eddc3473ab016615e2e55633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ankle</topic><topic>Ankle Fractures - surgery</topic><topic>Compression Bandages</topic><topic>Compression therapy</topic><topic>Critical Care Medicine</topic><topic>Dementia</topic><topic>Denmark</topic><topic>Emergency Medicine</topic><topic>Evidence-based medicine</topic><topic>Female</topic><topic>Fracture Fixation, Internal</topic><topic>Fractures</topic><topic>Gangrene</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Infections</topic><topic>Intensive</topic><topic>Intermittent Pneumatic Compression Devices</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Posture</topic><topic>Pressure</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Surgical site infections</topic><topic>Surgical Wound Infection - prevention & control</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Winge, Rikke</creatorcontrib><creatorcontrib>Ryge, Camilla</creatorcontrib><creatorcontrib>Bayer, Lasse</creatorcontrib><creatorcontrib>Klausen, Tobias Wirenfeldt</creatorcontrib><creatorcontrib>Gottlieb, Hans</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Winge, Rikke</au><au>Ryge, Camilla</au><au>Bayer, Lasse</au><au>Klausen, Tobias Wirenfeldt</au><au>Gottlieb, Hans</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2018-12-01</date><risdate>2018</risdate><volume>44</volume><issue>6</issue><spage>947</spage><epage>956</epage><pages>947-956</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract>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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29374780</pmid><doi>10.1007/s00068-017-0892-5</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-0501-8192</orcidid></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Ankle Ankle Fractures - surgery Compression Bandages Compression therapy Critical Care Medicine Dementia Denmark Emergency Medicine Evidence-based medicine Female Fracture Fixation, Internal Fractures Gangrene Humans Hypotheses Infections Intensive Intermittent Pneumatic Compression Devices Male Medicine Medicine & Public Health Middle Aged Original Article Posture Pressure Sports Medicine Surgery Surgical Orthopedics Surgical site infections Surgical Wound Infection - prevention & control Traumatic Surgery Treatment Outcome Young Adult |
| title | Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial |
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