Risk of peripheral artery occlusive disease in patients with lower leg fracture who received fixation and non-fixation treatments: A population cohort study

PLoS One. 2022 Aug 4;17(8):e0272068. doi: 10.1371/journal.pone.0272068. eCollection 2022.

Abstract

Background: The risk of peripheral artery occlusive disease (PAOD) in patients with lower leg fracture who underwent fixation procedures is not yet completely understood. Therefore, the current study aimed to examine the risk of subsequent PAOD in patients with lower leg fracture who received fixation and non-fixation treatments.

Methods: We included 6538 patients with lower leg fracture who received non-fixation treatment and a matched cohort comprising 26152 patients who received fixation treatment from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence and risk of PAOD in patients with lower leg fracture who received fixation and non-fixation treatments were evaluated via the stratification of different characteristics and comorbidities.

Results: Non-fixation treatment, male sex, older age (≥ 50 years old), diabetes mellitus, and gout were associated with a significantly higher risk of lower extremity PAOD compare to each comparison group, respectively. Moreover, there was a significant correlation between fixation treatment and a lower risk of lower extremity PAOD in women (adjusted hazard ratio [aHR] = 0.58, 95% confidence interval [CI] = 0.38-0.90), women aged > 50 years (aHR = 0.61, 95% CI = 0.38-0.96), and patients with coronary artery disease (aHR = 0.43, 95% CI = (0.23-0.81). Further, patients with fixation treatment had a significantly lower risk of lower extremity PAOD within 2 years after trauma (aHR = 0.57, 95% CI = 0.34-0.97). The Kaplan-Meier analysis showed that the cumulative incidence of PAOD was significantly higher in the non-fixation treatment group than in the fixation treatment group at the end of the 10-year follow-up period (log-rank test: P = 0.022).

Conclusion: Patients with lower leg fracture who received non-fixation treatment had a significantly higher risk of PAOD than those who received fixation treatment. Moreover, the risk of PAOD was higher in women aged > 50 years, as well as in coronary artery disease patients who received non-fixation treatment than in those who received fixation treatment. Therefore, regular assessment of vessel patency are recommended for these patients. Nevertheless, further studies must be conducted to validate the results of our study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arterial Occlusive Diseases* / complications
  • Arterial Occlusive Diseases* / epidemiology
  • Arterial Occlusive Diseases* / therapy
  • Arteries
  • Cohort Studies
  • Coronary Artery Disease* / complications
  • Female
  • Fractures, Bone* / epidemiology
  • Fractures, Bone* / surgery
  • Humans
  • Leg
  • Male
  • Middle Aged
  • Peripheral Arterial Disease* / complications
  • Peripheral Arterial Disease* / epidemiology
  • Peripheral Arterial Disease* / therapy
  • Risk Factors

Grants and funding

This study is supported in part by Ministry of Health and Welfare, Taiwan (109-TDU-B-212-114004), MOST Clinical Trial Consortium for Stroke (MOST 108-2321-B-039-003), China Medical University Hospital (DMR-111-048). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.