Peiyuan Wang, Chengsi Li, Lin Liu, Zihang Zhao, Zhiang Zhang, Kuo Zhao, Wei Chen, Yingze Zhang, Lin Jin, Zhiyong Hou
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The backward stepwise regression method was applied to identify independent risk factors associated with FB. The selected predictors were then entered into R software for further analysis and Nomogram construction.</p><p><strong>Results: </strong>In our research, the rate of FB (119 of 1,119) was 10.63%. Several predictors of FB were found using univariate analysis, including body mass index (BMI) (<i>p</i> < 0.001), the presence of DVT (<i>p</i> < 0.001), closed fractures (<i>p</i> < 0.001), time from injury to admission (<i>p</i> < 0.001), smoking history (<i>p</i> < 0.01), not utilizing dehydrating agents (<i>p</i> < 0.010), fixation mode of fracture (<i>p</i> < 0.001), the mode of surgical suture (<i>p</i> < 0.001), postoperative infection (<i>p</i> < 0.001) and Elixhauser comorbidity index (ECI) (<i>p</i> < 0.01). In addition, FB group exhibited significantly higher levels of blood serum indicators, such as EOS (<i>p</i> = 0.029), HCT (<i>p</i> < 0.01), LYM (<i>p</i> = 0.01), MPV (<i>p</i> = 0.014), NEU (<i>p</i> < 0.01), CKMB (<i>p</i> < 0.01), PLT (<i>p</i> < 0.01), ALB (<i>p</i> < 0.01), ALP (<i>p</i> < 0.01), AST (<i>p</i> < 0.01), CK (<i>p</i> = 0.019), CREA(<i>p</i> < 0.01), DBIL (<i>p</i> < 0.01), GLU (<i>p</i> < 0.01), Na (<i>p</i> < 0.01), P (<i>p</i> < 0.01), TC (<i>p</i> = 0.024), ALT (<i>p</i> < 0.01), TCO<sub>2</sub> (<i>p</i> < 0.01), TG (<i>p</i> < 0.01), TP (<i>p</i> < 0.01), UA (<i>p</i> = 0.018), UREA (<i>p</i> = 0.033) compared to the non-FB group. According to the stepwise logistic regression analysis, higher BMI (<i>p</i> = 0.011, OR 0.873, 95% CI 0.785-0.970), NEU (<i>p</i> = 0.036, OR 0.982, 95% CI 0.865-0.995) and CKMB (<i>p</i> < 0.014, OR 0.994, 95% CI 0.989-0.999) were associated with increased FB risk, while plate fixation (<i>p</i> = 0.017, OR 0.371, 95% CI 0.123-0.817), the mode of surgical suture (<i>p</i> < 0.01, OR 0.348, 95% CI 0.161-0.749), and postoperative infection (<i>p</i> = 0.020, OR 0.406, 95% CI 0.190-0.866) were also correlated with increased FB risk. The nomogram was established based on 6 predictors independently related to FB.</p><p><strong>Conclusions: </strong>Our investigation has shown that BMI, NEU, CKMB, plate fixation, the mode of surgical suture, and postoperative infection are independent risk factors for FB in patients with pilon fractures. The predictors identified by the nomogram could potentially be used to assess the possibility of blister formation, which could be a sign of fascial compartmental pressure release.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1401087"},"PeriodicalIF":1.6000,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499232/pdf/","citationCount":"0","resultStr":"{\"title\":\"Development and validation of a nomogram for predicting the risk of postoperative fracture blister after pilon fracture.\",\"authors\":\"Peiyuan Wang, Chengsi Li, Lin Liu, Zihang Zhao, Zhiang Zhang, Kuo Zhao, Wei Chen, Yingze Zhang, Lin Jin, Zhiyong Hou\",\"doi\":\"10.3389/fsurg.2024.1401087\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Fracture blister (FB) is one of the most common complications in pilon fractures. This study aimed to construct and validate a nomogram for predicting postoperative FB risk in patients with pilon fractures.</p><p><strong>Methods: </strong>We retrospectively collected information on 1,119 patients with lower extremity fractures in the 3rd Hospital of Hebei Medical University between January 2023 and January 2024. Patients with FBs were considered as the FB group and those without FB as the non-FB group. Variables with a significance level of <i>P</i> < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with FB. The selected predictors were then entered into R software for further analysis and Nomogram construction.</p><p><strong>Results: </strong>In our research, the rate of FB (119 of 1,119) was 10.63%. Several predictors of FB were found using univariate analysis, including body mass index (BMI) (<i>p</i> < 0.001), the presence of DVT (<i>p</i> < 0.001), closed fractures (<i>p</i> < 0.001), time from injury to admission (<i>p</i> < 0.001), smoking history (<i>p</i> < 0.01), not utilizing dehydrating agents (<i>p</i> < 0.010), fixation mode of fracture (<i>p</i> < 0.001), the mode of surgical suture (<i>p</i> < 0.001), postoperative infection (<i>p</i> < 0.001) and Elixhauser comorbidity index (ECI) (<i>p</i> < 0.01). In addition, FB group exhibited significantly higher levels of blood serum indicators, such as EOS (<i>p</i> = 0.029), HCT (<i>p</i> < 0.01), LYM (<i>p</i> = 0.01), MPV (<i>p</i> = 0.014), NEU (<i>p</i> < 0.01), CKMB (<i>p</i> < 0.01), PLT (<i>p</i> < 0.01), ALB (<i>p</i> < 0.01), ALP (<i>p</i> < 0.01), AST (<i>p</i> < 0.01), CK (<i>p</i> = 0.019), CREA(<i>p</i> < 0.01), DBIL (<i>p</i> < 0.01), GLU (<i>p</i> < 0.01), Na (<i>p</i> < 0.01), P (<i>p</i> < 0.01), TC (<i>p</i> = 0.024), ALT (<i>p</i> < 0.01), TCO<sub>2</sub> (<i>p</i> < 0.01), TG (<i>p</i> < 0.01), TP (<i>p</i> < 0.01), UA (<i>p</i> = 0.018), UREA (<i>p</i> = 0.033) compared to the non-FB group. According to the stepwise logistic regression analysis, higher BMI (<i>p</i> = 0.011, OR 0.873, 95% CI 0.785-0.970), NEU (<i>p</i> = 0.036, OR 0.982, 95% CI 0.865-0.995) and CKMB (<i>p</i> < 0.014, OR 0.994, 95% CI 0.989-0.999) were associated with increased FB risk, while plate fixation (<i>p</i> = 0.017, OR 0.371, 95% CI 0.123-0.817), the mode of surgical suture (<i>p</i> < 0.01, OR 0.348, 95% CI 0.161-0.749), and postoperative infection (<i>p</i> = 0.020, OR 0.406, 95% CI 0.190-0.866) were also correlated with increased FB risk. The nomogram was established based on 6 predictors independently related to FB.</p><p><strong>Conclusions: </strong>Our investigation has shown that BMI, NEU, CKMB, plate fixation, the mode of surgical suture, and postoperative infection are independent risk factors for FB in patients with pilon fractures. 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引用次数: 0
摘要
背景：骨折水疱（FB）是Pilon骨折最常见的并发症之一。本研究旨在构建并验证预测皮隆骨折患者术后 FB 风险的提名图：我们回顾性收集了 2023 年 1 月至 2024 年 1 月期间河北医科大学第三医院 1,119 例下肢骨折患者的信息。有 FB 的患者为 FB 组，无 FB 的患者为非 FB 组。变量的显著性水平为 P 结果：在我们的研究中，FB（1119 例中的 119 例）的发生率为 10.63%。通过单变量分析发现了一些预测 FB 的因素，包括体重指数（BMI）（P P P P P P P P P P P = 0.029）、HCT（P P = 0.01）、MPV（P = 0.014）、NEU（p p p p p p p = 0.019）、CREA（p p p p p p = 0.024）、ALT（p 2 （p p p p = 0.018）、UREA（p = 0.033）。根据逐步逻辑回归分析，BMI（p = 0.011，OR 0.873，95% CI 0.785-0.970）、NEU（p = 0.036，OR 0.982，95% CI 0.865-0.995）和 CKMB（p p = 0.017，OR 0.371，95% CI 0.123-0.817），手术缝合方式（p p = 0.020，OR 0.406，95% CI 0.190-0.866）也与 FB 风险增加相关。该提名图是根据与 FB 独立相关的 6 个预测因子建立的：我们的研究表明，BMI、NEU、CKMB、钢板固定、手术缝合方式和术后感染是Pilon骨折患者发生FB的独立风险因素。提名图所确定的预测因素可用于评估水泡形成的可能性，这可能是筋膜室压力释放的迹象。
Development and validation of a nomogram for predicting the risk of postoperative fracture blister after pilon fracture.
Background: Fracture blister (FB) is one of the most common complications in pilon fractures. This study aimed to construct and validate a nomogram for predicting postoperative FB risk in patients with pilon fractures.
Methods: We retrospectively collected information on 1,119 patients with lower extremity fractures in the 3rd Hospital of Hebei Medical University between January 2023 and January 2024. Patients with FBs were considered as the FB group and those without FB as the non-FB group. Variables with a significance level of P < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with FB. The selected predictors were then entered into R software for further analysis and Nomogram construction.
Results: In our research, the rate of FB (119 of 1,119) was 10.63%. Several predictors of FB were found using univariate analysis, including body mass index (BMI) (p < 0.001), the presence of DVT (p < 0.001), closed fractures (p < 0.001), time from injury to admission (p < 0.001), smoking history (p < 0.01), not utilizing dehydrating agents (p < 0.010), fixation mode of fracture (p < 0.001), the mode of surgical suture (p < 0.001), postoperative infection (p < 0.001) and Elixhauser comorbidity index (ECI) (p < 0.01). In addition, FB group exhibited significantly higher levels of blood serum indicators, such as EOS (p = 0.029), HCT (p < 0.01), LYM (p = 0.01), MPV (p = 0.014), NEU (p < 0.01), CKMB (p < 0.01), PLT (p < 0.01), ALB (p < 0.01), ALP (p < 0.01), AST (p < 0.01), CK (p = 0.019), CREA(p < 0.01), DBIL (p < 0.01), GLU (p < 0.01), Na (p < 0.01), P (p < 0.01), TC (p = 0.024), ALT (p < 0.01), TCO2 (p < 0.01), TG (p < 0.01), TP (p < 0.01), UA (p = 0.018), UREA (p = 0.033) compared to the non-FB group. According to the stepwise logistic regression analysis, higher BMI (p = 0.011, OR 0.873, 95% CI 0.785-0.970), NEU (p = 0.036, OR 0.982, 95% CI 0.865-0.995) and CKMB (p < 0.014, OR 0.994, 95% CI 0.989-0.999) were associated with increased FB risk, while plate fixation (p = 0.017, OR 0.371, 95% CI 0.123-0.817), the mode of surgical suture (p < 0.01, OR 0.348, 95% CI 0.161-0.749), and postoperative infection (p = 0.020, OR 0.406, 95% CI 0.190-0.866) were also correlated with increased FB risk. The nomogram was established based on 6 predictors independently related to FB.
Conclusions: Our investigation has shown that BMI, NEU, CKMB, plate fixation, the mode of surgical suture, and postoperative infection are independent risk factors for FB in patients with pilon fractures. The predictors identified by the nomogram could potentially be used to assess the possibility of blister formation, which could be a sign of fascial compartmental pressure release.
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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