ABSTRACT
AIMS: Lifestyle risk factors are thought to increase the risk of infection after acute orthopaedic surgery but the evidence is scarce. We aimed to investigate whether smoking, obesity and alcohol overuse are risk factors for the development of infections after surgery for a fracture of the ankle. PATIENTS AND METHODS: We retrospectively reviewed all patients who underwent internal fixation of a fracture of the ankle between 2008 and 2013. The primary outcome was the rate of deep infection and the secondary outcome was any surgical site infection (SSI). Associations with the risk factors and possible confounding variables were analysed univariably and multivariably with backwards elimination. RESULTS: A total of 1043 patients were included; 64 (6.1%) had a deep infection and 146 (14.0%) had SSI. Obesity was strongly associated with both outcomes (odds ratio (OR) 2.21, p = 0.017 and OR 1.68, p = 0.032) in all analyses. Alcohol overuse was similarly associated, though significant only in unadjusted analyses. Surprisingly, smoking did not yield statistically significant associations with infections. CONCLUSION: These findings suggest that obesity and possibly alcohol overuse are independent risk factors for the development of infection following surgery for a fracture of the ankle. This large study brings new evidence concerning these common risk factors; although prospective studies are needed to confirm causality. Cite this article: Bone Joint J 2017;99-B:225-30.
Subject(s)
Ankle Fractures/surgery , Fracture Fixation, Internal/adverse effects , Health Behavior , Life Style , Surgical Wound Infection/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Alcoholism/complications , Ankle Fractures/complications , Child , Female , Humans , Male , Middle Aged , Obesity/complications , Retrospective Studies , Risk Assessment , Risk Factors , Smoking/adverse effects , Young AdultABSTRACT
BACKGROUND: The dominant discourse of popular media appears to paint a disparaging picture of parents deemed overly concerned about their children's safety. Child injury prevention interventions frequently focus on influencing parenting behaviours. Fathers are increasingly involved in childcare, highlighting the need to understand their perspectives on overprotective parenting as it relates to considerations of injury prevention while actively engaged with their children. METHODS: Qualitative interviews were carried out with 32 fathers of children aged 2-7 years in a Canadian urban setting. Interview questions investigated fathers' injury prevention attitudes and practices, and their beliefs regarding overprotection. Data analysis was guided by grounded theory methods. RESULTS: Fathers noted the subjective nature of overprotection, citing family, social and situational factors that shaped their views. Fathers viewed overprotective parents as experiencing excessive fears that were manifested in lack of willingness to risk physical or psychological injury. They described overprotective parenting as including over-involvement in and excessive restriction of children's activities; and expressed concerns that the results of these behaviours would be children lacking self-confidence and crucial life skills. CONCLUSION: Fathers viewed as problematic overprotective parenting behaviours that limit access to opportunities for physical risk taking in an attempt to prevent mostly minor injuries. The injury prevention field may benefit from considering fathers' perspectives when designing programmes to minimize the likelihood that safety initiatives may be perceived as promoting overprotection of children. Framing safety messages in ways that align with fathers' views could involve promoting appropriate protection and encouraging an active lifestyle.
