Objective To explore the related factors of surgical site infection (SSI) in diabetic patients undergoing plate fixation for distal radius fractures. Methods A retrospective analysis was conducted on 897 patients who suffered from diabetes mellitus and underwent palmar locking plate fixation for unstable distal radius fractures in the Henan Provincial Corps Hospital of Chinese People's Armed Police Force from January 2012 to June 2023. The patients were divided into two groups based on whether SSI occurred. Univariate analysis was used to compare the factors, and binary variable multivariate logistic regression analysis was used to analyze the risk factors of SSI. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of the model. Results Among the 897 patients, 43 patients (4.79%) developed SSI. The results of univariate analysis showed that the SSI group was significantly younger than the non-SSI group, and the difference was statistically significant (P=0.029), and the SSI group proved significantly higher than the non-SSI group in terms of proportion of male ,smoking, American Society of Anesthesiologists (ASA) classification, general anesthesia ratio [n, general/region, bone grafting ratio and blood loss, and the differences were statistically significant (P＜0.05). Regarding preoperative laboratory tests, the SSI group had significantly higher white blood cell count, whereas significantly lower red blood cell count, hemoglobin, hematocrit, sodium, and albumin than the non-SSI group, and the differences were statistically significant (P＜0.05). Multivariate logistic regression analysis demonstrated that male gender (OR=2.83, 95%CI: 1.33～5.99, P=0.007), ASA classification Ⅳ (OR=4.41, 95%CI: 1.47～13.25, P=0.008), smoking (OR=2.37, 95%CI: 1.20～4.69, P=0.013), and bone grafting (OR=3.20, 95%CI: 1.18～8.68, P=0.022) were independent risk factors for SSI development. The area under the ROC curve of the predictive model was 0.771, demonstrating good discriminative ability. Conclusions For diabetic patients undergoing palm locking plate treatment for unstable distal radius fractures, special attention should be paid to high-risk patients such as males, those with worsened systemic diseases, those with a smoking history, and those requiring bone grafts. It is recommended to quit smoking before the surgery, strictly optimize blood sugar control, reasonably select indications for bone grafting, strengthen infection prevention measures during the perioperative period, and develop individualized monitoring plans to reduce the risk of surgical site infection and improve patient prognosis.
Key words
diabetes /
distal radius fracture /
volar locking plate /
surgical site infection /
risk factors
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References
[1] Vilaca T,Schini M,Harnan S,et al.The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: a systematic review and meta-analysis update[J].Bone,2020,137(8):115457.
[2] Dou J,Wang J,Zhang Q,et al.Differences in the roles of types 1 and 2 diabetes in the susceptibility to the risk of fracture: a systematic review and meta-analysis[J].Diabetol Metab Syndr,2021,13(1):84-89.
[3] Ha J,Jeong C,Han K D,et al.Comparison of fracture risk between type 1 and type 2 diabetes: a comprehensive real-world data[J].Osteoporos Int,2021,32(12):2543-2553.
[4] Vilaca T,Paggiosi M,Walsh J S,et al.The effects of type 1 diabetes and diabetic peripheral neuropathy on the musculoskeletal system: a case-control study [J].J Bone Miner Res,2020,36(6):1048-1059.
[5] Agarwal S,Germosen C,Rosillo I,et al.Fractures in women with type 2 diabetes are associated with marked deficits in cortical parameters and trabecular plates [J].J Bone Miner Res,2024,39(8):1083-1093.
[6] Nandakumar D,Conover B M,Johnson M J,et al.Outcomes of open or closed treatment of foot fractures: a database study comparing patients with and without diabetes[J].J Foot Ankle Surg,2025,64(5):655-659.
[7] Van Hulten V,Rasmussen N,Driessen J H M,et al.Fracture patterns in type 1 and type 2 diabetes mellitus: a narrative review of recent literature[J].Curr Osteoporos Rep,2021,19(6):644-655.
[8] Tanios M,Brickman B,Cage E,et al.Diabetes and impaired fracture healing: a narrative review of recent literature[J].Curr Osteoporos Rep,2022,20(5):229-239.
[9] Sheu A,Bliuc D,Tran T,et al.Fractures in type 2 diabetes confer excess mortality: the dubbo osteoporosis epidemiology study[J].Bone,2022,159:116373.
[10] Galivanche A R,FitzPatrick S,Dussik C,et al.A matched comparison of postoperative complications between smokers and nonsmokers following open reduction internal fixation of distal radius fractures[J].J Hand Surg,2021,46(1):1-9.
[11] Newton W N,Johnson C A,Daley D N.Risk factors for 30-day complications and unplanned reoperation following surgical treatment of distal radius fractures [J].Hand,2024,19(4):622-628.
[12] Pacchiarini L,Oldrini L M,Feltri P,et al.Complications after volar plate synthesis for distal radius fractures[J]. EFORT Open Rev,2024,9(6):567-580.
[13] Yaradılmş Y U,Tecirli A,Örs Ç.Distal radius correction osteotomy with tricortical bone graft is a successful method in heavy smokers [J]. J Orthop,2020,18:150-154.
[14] Faraj M,Schwartz A V,Burghardt A J,et al.Risk factors for bone microarchitecture impairments in older men with type 2 diabetes-the MrOS study[J].J Clin Endocrinol Metab,2025,110(5):e1660-e1669.
[15] Samakkarnthai P,Sfeir J G,Atkinson E J,et al.Determinants of bone material strength and cortical porosity in patients with type 2 diabetes mellitus [J].J Clin Endocrinol Metab,2020,105(10):e3718-e3729.
[16] Van Hulten V,Sarodnik C,Driessen J H,et al.Bone microarchitecture and strength assessed by HRpQCT in individuals with type 2 diabetes and prediabetes: the Maastricht study [J].JBMR Plus,2024,8(9):z086.
[17] Sewing L,Potasso L,Baumann S,et al.Bone microarchitecture and strength in long-standing type 1 diabetes[J]. J Bone Miner Res,2020,37(5):837-847.
[18] Ho-Pham L,Nguyen T.Association between trabecular bone score and type 2 diabetes: a quantitative update of evidence [J].Osteoporosis Int,2019,30:2079-2085.
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