Complications, current practice and controversies in lower extremity fracture surgery

Surgical site infections occur frequently following lower extremity fracture surgery. The first part of this thesis focusses on methods to reduce the number of surgical site infections following lower extremity fracture surgery. In the second chapter the effect of administering antibiotic prophylaxis on the incidence of surgical site infections following implant removal below the level of the knee was studied. We found no beneficial effect of administering antibiotic prophylaxis. Prophylactic negative pressure wound therapy however showed promising when applied on patients undergoing osteosynthesis of a lower extremity fracture. In the second part of this thesis current practice in lower extremity fracture surgery was studied. We found that local anesthesia provided equal anesthetic effects compared with regional anesthesia in patients undergoing osteosynthesis of a calcaneal fracture. Furthermore we studied which patients are at risk for the development of complications following a posttraumatic subtalar arthrodesis. We found that patients who suffered from a surgical site infections following osteosynthesis, are at risk for the development of a surgical site infection following a subtalar arthrodesis. In another study we found that, despite the sacrifice of the subtalar joint, the functional outcome of patients undergoing a primary subtalar arthrodesis was equal to patients undergoing osteosynthesis. In the last part the need for routine syndesmotic screw removal was studied. A future randomized study on this subject should provide more definitive answer regarding this subject.