Kadar hemoglobin, konfigurasi fraktur, dan kerusakan jaringan sebagai faktor risiko terjadinya infeksi luka operasi pasca open reduction internal fixation fraktur tertutup tulang panjang ekstremitas bawah

I Gusti Bagus Indra Angganugraha Putra Juniantara; I Ketut Siki Kawiyana; Ketut Gede Mulyadi Ridia; Putu Astawa; I Ketut Suyasa; I Wayan Suryanto Dusak; I Gede Eka Wiratnaya

doi:10.15562/medicina.v52i1.1032

Kadar hemoglobin, konfigurasi fraktur, dan kerusakan jaringan sebagai faktor risiko terjadinya infeksi luka operasi pasca open reduction internal fixation fraktur tertutup tulang panjang ekstremitas bawah

I Gusti Bagus Indra Angganugraha Putra Juniantara ,

I Ketut Siki Kawiyana ,

Ketut Gede Mulyadi Ridia ,

Putu Astawa ,

I Ketut Suyasa ,

I Wayan Suryanto Dusak ,

I Gede Eka Wiratnaya ,

PDF |
DOI: https://doi.org/10.15562/medicina.v52i1.1032 |
Published: 2021-04-01

Abstract

Background: The occurrence of fractures is often found in clinical practice in hospitals. Patients who come to the hospital emergency department with a mechanism of traffic accidents or other accidents. Operations in orthopedic cases, especially in lower limb fractures which are done by internal fixation have a risk of surgical wound infection can even occur in closed fracture cases. The importance of early detection of the possibility of infection so prevention can be done either by wound care or antibiotic administration. Hemoglobin levels, fracture configuration, and tissue damage are thought to be the most important risk factors for the incidence of infection in lower extremity closed fractures.

Methods. The study used an observational analytic design with a Case Control approach to determine whether Hb levels, fracture configuration, tissue damage as risk factors for surgical wound infection with marked increase in procalcitonin in patients with long extremity closed bone fractures after an open reduction internal fixation

Results. From the study, there were significant incidences of surgical wound infections in patients who had postoperative Hb levels <11g / dl, fractures with complex configurations, and the presence of Tscherne soft tissue injuries 1,2,3 in patients with post-extremity long-closed bone fractures. open reduction internal fixation is done. Where the greatest strength of relationship to the incidence of infection is fracture configuration (OR = 0.222), while the smallest relationship strength is soft tissue injury (OR = 0.134).

Discussion: A number of studies have been carried out to look for risk factors for the incidence of infection in patients with fractures after surgery with internal fixation so as to minimize the incidence of infection. From these studies, several researchers found that the incidence of post-internal fixation infection was caused by a variety of main factors, namely pre and postoperative hemoglobin levels, the degree of tissue damage, and fracture configuration, but further research had to be done using a larger sample and with better research methods.

Conclusion. Hb level <11, complex fracture configuration, Tscherne soft tissue injury 1,2,3 showed a positive correlation in the incidence of infection in patients with closed lower limb fractures after internal fixation.

Latar Belakang: Kejadian fraktur sering ditemukan dalam praktek klinis di rumah sakit. Pasien yang datang ke unit gawat darurat rumah sakit dengan mekanisme kecelakaan lalu lintas atau kecelakaan lainnya. Operasi pada kasus orthopaedi khususnya pada fraktur ekstremitas bawah yang dilakukan pemasangan internal fiksasi memiliki resiko infeksi luka operasi bahkan dapat terjadi pada kasus fraktur tertutup. Pentingnya deteksi sejak dini kemungkinan terjadinya infeksi sehingga dapat dilakukan pencegahan baik dengan perawatan luka ataupun pemberian antibiotik. Kadar hemoglobin, konfigurasi fraktur, dan kerusakan jaringan diduga menjadi faktor resiko yang paling berperan terhadap kejadian infeksi pada fraktur tertutup ekstremitas bawah.

Metode: Penelitian menggunakan rancangan observational analitik dengan pendekatan Case Control untuk mengetahui apakah kadar Hb, konfigurasi fraktur, kerusakan jaringan sebagai faktor risiko terjadinya infeksi luka operasi dengan ditandai peningkatan procalcitonin pada pasien fraktur tertutup tulang panjang extremitas bawah pasca dilakukan open reduction internal fixation

Hasil: Dari penelitian didapatkan insiden terjadinya infeksi luka operasi yang signifikan pada pasien yang memiliki kadar Hb pasca operasi < 11g/dl, fraktur dengan konfigurasi kompleks, dan adanya cedera jaringan lunak Tscherne 1,2,3 pada pasien fraktur tertutup tulang panjang extremitas bawah pasca dilakukan open reduction internal fixation. Dimana kekuatan hubungan terbesar terhadap kejadian infeksi adalah konfigurasi fraktur (OR=0,222), sedangkan kekuatan hubungan terkecil adalah cedera jaringan lunak (OR=0,134).

Pembahasan: Sejumlah penelitian telah dilakukan untuk mencari faktor-faktor resiko kejadian infeksi pada pasien dengan fraktur setelah dilakukan operasi dengan pemasangan fiksasi internal sehingga dapat meminimalisir kejadian infeksi. Dari penelitian tersebut beberapa peneliti menemukan bahwa kejadian infeksi pasca fiksasi internal disebabkan oleh berbagai faktor utamanya adalah kadar hemoglobin pra dan pasca operasi, derajat kerusakan jaringan, dan konfigurasi fraktur, namun penelitian lanjutan masih harus dilakukan dengan menggunakan sampel yang lebih besar dan dengan metode penelitian yang lebih baik.

Kesimpulan : Kadar Hb < 11, konfigurasi fraktur kompleks, cedera jaringan lunak Tscherne 1,2,3 menunjukkan korelasi positif pada insiden infeksi pada pasien fraktur tertutup ekstremitas bawah setelah dilakukan fiksasi interna

References

Jain RK, Shukla R, Singh P, Kumar R. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery. Eur J Orthop Surg Traumatol 2015; 25: 251–254.
Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: State-of-the-art update. J Hosp Infect 2013; 84: 5–12.
Harrison T, Robinson P, Cook A, Parker MJ. Factors affecting the incidence of deep wound infection after hip fracture surgery. J Bone Jt Surg - Ser B 2012. doi:10.1302/0301-620X.94B2.27683.
Bou Monsef J, Boettner F. Blood Management May Have an Impact on Length of Stay After Total Hip Arthroplasty. HSS J 2014. doi:10.1007/s11420-014-9384-x.
Weber WP, Zwahlen M, Reck S, Misteli H, Rosenthal R, Buser AS et al. The association of preoperative anemia and perioperative allogeneic blood transfusion with the risk of surgical site infection. Transfusion 2009. doi:10.1111/j.1537-2995.2009.02204.x.
Dunkel N, Pittet D, Tovmirzaeva L, Suvà D, Bernard L, Lew D et al. Short duration of antibiotic prophylaxis in open fractures does not enhance risk of subsequent infection. Bone Jt J 2013. doi:10.1302/0301-620X.95B6.30114.
Bowen TR, Widmaier JC. Host classification predicts infection after open fracture. Clin Orthop Relat Res 2005. doi:10.1097/01.blo.0000150345.51508.74.
Clinical and Demographic Study on Open Fractures. 2014; 22: 214–218.
Matos MA, Lima LG, de Oliveira LAA. Predisposing factors for early infection in patients with open fractures and proposal for a risk score. J Orthop Traumatol 2015; 16: 195–201.
Hunziker S, Hügle T, Schuchardt K, Groeschl I, Schuetz P, Mueller B et al. The value of serum procalcitonin level for differentiation of infectious from noninfectious causes of fever after orthopaedic surgery. J Bone Jt Surg - Ser A 2010; 92: 138–148.
Weckbach S, Perl M, Heiland T, Braumüller S, Stahel PF, Flierl MA et al. A new experimental polytrauma model in rats: molecular characterization of the early inflammatory response. Mediators Inflamm 2012.
Ren T, Ding L, Xue F, He Z, Xiao H. Risk factors for surgical site infection of pilon fractures. Clinics 2015. doi:10.6061/clinics/2015(06)06.
Al-Arabi YB, Nader M, Hamidian-Jahromi AR, Woods DA. The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: A 9-year prospective study from a district general hospital. Injury 2007. doi:10.1016/j.injury.2007.02.043.
Bachoura A, Guitton TG, Malcolm Smith R, Vrahas MS, Zurakowski D, Ring D. Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care. Clin Orthop Relat Res 2011; 469: 2621–2630.
Bowler PG. Wound pathophysiology, infection and therapeutic options. Ann Med 2002; 34: 419–427.