Association between periodontitis and fracture-related infection in patients with severe open fractures of the upper and/or lower extremities.

backgroundPeriodontitis is a chronic inflammatory condition that affects the oral cavity and has systemic implications beyond its localized impact, potentially increasing the risk of various health issues. This study aimed to investigate the role of periodontitis as a risk factor for fracture-related infection (FRI), a severe complication encountered in orthopaedic trauma.

methodsA prospective cohort study was conducted to analyze data from 235 patients with severe open fractures (grades II, IIIA, or IIIB) who were monitored for at least 12 months. During the perioperative period, the periodontal health of these patients was evaluated through various clinical measures, including clinical attachment levels, bleeding on probing (BOP), and probing depth, which were used to identify instances of periodontitis. Additionally, the Simplified Oral Hygiene Index (OHI-S) was employed as part of the assessment. Comprehensive data were collected for subsequent analysis. To explore the associations between periodontal status and the occurrence of FRI, statistical methods, including both univariate and multivariate regression models, were applied FRI, with a significance level set at 5%.

resultsAmong 235 patients, 169 individuals (71.9%) exhibited normal wound healing, while 66 patients (28.1%) developed FRI. The data analyses indicated a significant association between periodontitis and an increased risk of FRI, with an adjusted risk ratios (RR) of 3.03 (95% CI: 1.02-9.44, p = 0.045). Additionally, elevated BOP levels were identified as an independent risk factor, with an adjusted RR of 1.02 (95% CI: 1.00-1.04, p = 0.035). Advanced stages of periodontitis, particularly Stage II (adjusted RR 2.63, 95% CI: 1.11-6.18, p = 0.02) and Stage III (adjusted RR 3.06, 95% CI: 1.53-6.20, p = 0.001), were strongly linked to higher rates of FRI. Notably, the presence of periodontitis was significantly associated with early FRI occurrences (proportion difference 0.3658, 95% CI: 0.240-0.491, p < 0.0001), while no significant association was observed with late or delayed FRI cases. Moreover, additional factors influencing the risk of FRI included the severity of open fracture and delayed wound closure.

conclusionsPeriodontitis was significantly associated with an increased risk of developing FRI in patients with open fractures. Advanced stages of periodontal disease and elevated BOP are recognized as independent risk factors. Additionally, other important contributing factors include the severity of the open fractures and delayed wound closure.