Original Article
Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag®?
¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag®?
Read
1146
Timeswas read the article
286
Total PDF
860
Total HTML
Share statistics
array:24 [ "pii" => "S1988885619300537" "issn" => "19888856" "doi" => "10.1016/j.recote.2019.04.007" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "807" "copyright" => "SECOT" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:342-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1888441519300669" "issn" => "18884415" "doi" => "10.1016/j.recot.2019.04.003" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "807" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:342-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 146 "formatos" => array:2 [ "HTML" => 104 "PDF" => 42 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag<span class="elsevierStyleSup">®</span>?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "342" "paginaFinal" => "345" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag<span class="elsevierStyleSup">®</span>?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Luque-Valenzuela, A.J. Sánchez-Aguilera, A. Martín-Vivaldi-Jiménez, R. Jódar-Graus, N. Prados-Olleta" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Luque-Valenzuela" ] 1 => array:2 [ "nombre" => "A.J." "apellidos" => "Sánchez-Aguilera" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Martín-Vivaldi-Jiménez" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Jódar-Graus" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Prados-Olleta" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1988885619300537" "doi" => "10.1016/j.recote.2019.04.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885619300537?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441519300669?idApp=UINPBA00004N" "url" => "/18884415/0000006300000005/v2_201910021010/S1888441519300669/v2_201910021010/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1988885619300525" "issn" => "19888856" "doi" => "10.1016/j.recote.2019.07.002" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "806" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:346-54" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 1 "PDF" => 3 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Comparative cohort study of the SuperPath approach and the conventional posterior approach in primary cementless hip replacement surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "346" "paginaFinal" => "354" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de cohortes comparativo del abordaje Superpath con abordaje convencional posterior en cirugía protésica primaria de cadera no cementada: curva de aprendizaje y resultados a corto plazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 874 "Ancho" => 850 "Tamanyo" => 51111 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Left hip. Preoperative radiology. Measuring the distance between the lateral area of the acetabular rim and the apex of the greater trochanter.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Más Martínez, J. Sanz-Reig, M. Morales-Santías, D. Bustamante Suarez de Puga, C. Verdu Roman, E. Martinez Gimenez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Más Martínez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sanz-Reig" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Morales-Santías" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Bustamante Suarez de Puga" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Verdu Roman" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Martinez Gimenez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885619300525?idApp=UINPBA00004N" "url" => "/19888856/0000006300000005/v1_201909060709/S1988885619300525/v1_201909060709/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1988885619300458" "issn" => "19888856" "doi" => "10.1016/j.recote.2019.06.002" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "808" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:336-41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Talus fractures. Functional results for polytraumatized patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "336" "paginaFinal" => "341" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracturas de astrágalo. Resultados funcionales en pacientes politraumatizados" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 965 "Ancho" => 1583 "Tamanyo" => 40720 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Surgical delay according to group.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. Hierro-Cañas, P. Andrés-Cano, G. Rabadán-Márquez, M.A. Giráldez-Sánchez, P. Cano-Luis" "autores" => array:5 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Hierro-Cañas" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Andrés-Cano" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Rabadán-Márquez" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Giráldez-Sánchez" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Cano-Luis" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441519300670" "doi" => "10.1016/j.recot.2019.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441519300670?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885619300458?idApp=UINPBA00004N" "url" => "/19888856/0000006300000005/v1_201909060709/S1988885619300458/v1_201909060709/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag<span class="elsevierStyleSup">®</span>?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "342" "paginaFinal" => "345" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Luque-Valenzuela, A.J. Sánchez-Aguilera, A. Martín-Vivaldi-Jiménez, R. Jódar-Graus, N. Prados-Olleta" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Luque-Valenzuela" "email" => array:1 [ 0 => "marialuquevalenzuela@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A.J." "apellidos" => "Sánchez-Aguilera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Martín-Vivaldi-Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Jódar-Graus" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "N." "apellidos" => "Prados-Olleta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag<span class="elsevierStyleSup">®</span>?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ankle fractures account for 10% of all fractures. Most require open reduction and internal fixation (ORIF) for anatomical reduction of the joint.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> In spite of the fact that the results are generally good, treatment of surgical site complications remains a problem for the traumatologist.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> Wound complications include dehiscence, necrosis and infection.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> The incidence of surgical site infection, the most feared skin complication, ranges between 1.4% and 5.5%, depending on the publication.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> Risk factors linked to such infections include open fractures, diabetes mellitus, tobacco habit and advanced age.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5–10</span></a> Their treatment varies depending on the severity, including from local treatment up to removal of the tissue and intravenous antibiotic treatment. The most frequently isolated microorganisms are <span class="elsevierStyleItalic">Staphylococcus aureus</span>, Coagulase-Negative <span class="elsevierStyleItalic">Staphylococci</span> and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>. In recent years, the rate of multi-resistant strains has increased greatly, to the point of being isolated in 60% of the infections.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Due to the increase in both personal and economic costs that these complications entail, several preventative measures have been investigated.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Some studies suggest that the type of dressing used can create a barrier that decreases the access of the bacteria to the surgical site wound.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> Theoretically, dressings impregnated with silver are antimicrobial and, thanks to their capacity to absorb exudates, prevent the skin from macerating, promoting healing.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The main objective of this study was to determine if treating the surgical site after open reduction and internal fixation of an ankle fracture with silver-impregnated dressings would reduce the incidence of wound complications in comparison with sterile dressing treatment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">After obtaining the approval of our Ethics Committee, the personal, radiographic and medical data of 233 patients that had undergone interventions for ankle fracture in our hospital between July 2017 and February 2018 were collected. The inclusion criteria for the study were as follows: age between 18 and 80 years and signed informed consent. All the patients with open, tibial pilon or Maisonneuve fractures, polytrauma cases and patients with dermatological pathology in the area of the surgical approach were excluded.</p><p id="par0025" class="elsevierStylePara elsevierViewall">From 1 July 2017, a group of traumatologists began to apply silver-impregnated dressings (Aquacel Ag Extra<span class="elsevierStyleSup">®</span>), thereby creating two cohorts based on whether the patient underwent an intervention before or after the beginning of the study: patients on whom sterile dressings were used and those on whom silver-impregnated dressings were used to cover the surgical site. The rest of the operating theatre protocol was the same for both groups: use of tourniquet on the thigh, antibiotic prophylaxis with cefazolin 1<span class="elsevierStyleHsp" style=""></span>g an hour before performing the incision, antithrombotic prophylaxis with low molecular weight heparin and skin preparation by cleansing with chlorhexidine. The first treatment carried out from 2 to 6 days postoperatively was supervised by a specialised nurse who filled out the ASEPSIS wound scoring scale for each patient. The patients were also followed up in office visits with the Traumatologist for 3 months. The ASEPSIS scale is a scale for evaluating the state of a postoperative wound, published in <span class="elsevierStyleItalic">The Lancet</span> journal in 1986, as a useful tool to standardise how a wound is described (Appendix B, Supplementary material appendixes 1 and 2).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Statistical analysis was carried out with the IBM Statistical Package program version 19.0. The Mann–Whitney and Chi-square tests were used to detect statistically significant differences (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05) between the 2 groups.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">For 3 months, 54 patients in the cohort in which silver-impregnated dressings were used and 179 patients in the cohort in which sterile dressings were used were followed up. The incidence of surgical site complications in the first group was 7.4% (4/54), while it was 10% (18/179) in the second group. The complications were mostly minor and were handled with local treatments and oral antibiotics. There was only 1 infection that required surgical debridement and intravenous antibiotic treatment. None of the complications recorded were attributed to patient characteristics, use of immobilizations or wound treatment method. All the data collected on the different complications are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Statistical analysis did not show any statistically significant differences between the 2 groups. The independent variables analysed can be seen in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Surgical site infection constitutes the most frequently acquired hospital infection, accounting for 38% of the nosocomial infections.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> There are several studies that encourage the use of dressings impregnated with silver to reduce the incidence of these complications because they optimise wound healing thanks to their capacity to eliminate dead spaces and absorb exudates. They are also a barrier against exogenous bacteria.</p><p id="par0050" class="elsevierStylePara elsevierViewall">A systematic review carried out by Cochrane in 2014 included 20 controlled randomised trials to determine if dressings with silver were useful to reduce surgical wound infections after operations with primary closure. However, the conclusion was reached that the evidence to support this was too limited to establish whether any type of dressing reduced these complications.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Kadar et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> published a prospective randomised clinical trial in which the efficacy of silver-impregnated dressings for both reducing skin colonisation after hip fracture surgery in the elderly and reducing infection of the surgical site wound remained unproven.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Galli et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> carried out a prospective study with 59 patients that had foot and ankle surgery with incisions larger than 1<span class="elsevierStyleHsp" style=""></span>cm. The incidence of wound complications in the group treated using sterile dressings (26.67%) was significantly greater than that of the group treated with silver-impregnated dressings (3.45%) (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.03).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Grosso et al.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> published a study that found a significant reduction of periprosthetic infection after using treatments with silver-impregnated dressings compared with standard sterile dressings. In 2018, the American Academy of Orthopaedic Surgery stated that using silver-impregnated dressings was useful in reducing periprosthetic infection following primary arthroplasty.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The main limitations of this study are the limited number of patients in the cohorts and the lack of randomisation. However, the strong points of the study include the fact that it is a prospective study and that all the patients have been treated in the same hospital, following a standardised protocol. On another note, cost-effectiveness studies would be necessary to demonstrate whether the possible reduction in the rate of surgical site complications from using silver-impregnated dressings in all surgically-treated ankle fractures would be greater than the expense of using them.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Surgical site complications after ankle fracture surgery continue to be one of the main complications of this surgery. However, reducing their incidence can lead to a relevant improvement in functional results and patient satisfaction, consequently leading to a decrease in costs. Despite the fact that the use of silver-impregnated dressings has increased in recent years, the evidence as to their efficacy in Orthopaedic Surgery and Traumatology is limited. Most of the studies present a low level of evidence (this article has a level of evidence II) and there are very few controlled and randomised clinical trials. In our opinion, further controlled randomised trials are needed to make it possible to establish the indication for the use of silver-impregnated dressings in our speciality.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">This research has not received any specific funding from public sector agencies, the commercial sector or non-profit entities.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1239358" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1150225" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1239357" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1150224" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:2 [ "identificador" => "xack424271" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-12-11" "fechaAceptado" => "2019-04-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1150225" "palabras" => array:4 [ 0 => "Ankle fracture" 1 => "Skin complication" 2 => "Surgical site infection" 3 => "Silver dressings" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1150224" "palabras" => array:4 [ 0 => "Fractura de tobillo" 1 => "Complicación cutánea" 2 => "Infección del sitio quirúrgico" 3 => "Apósitos de plata" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ankle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra<span class="elsevierStyleSup">®</span>) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra<span class="elsevierStyleSup">®</span> from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months’ follow-up.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The statistical analysis showed that there is no difference in the prevalence of skin complications between both groups.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The theoretical advantages of silver impregnated dressings need further prospective randomised controlled studies to assess the appropriate indications for their use in orthopaedic surgery.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las fracturas de tobillo representan un 10% del total de fracturas. La mayor parte requieren tratamiento quirúrgico, que conlleva un importante riesgo de complicaciones de la herida. El objetivo de este estudio ha sido determinar si los apósitos impregnados con plata (Aquacel Ag Extra<span class="elsevierStyleSup">®</span>) reducen la tasa de complicaciones de la herida quirúrgica tras el tratamiento de las fracturas de tobillo en comparación con el uso de gasas estériles.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De forma prospectiva se han reunido 233 pacientes con fracturas de tobillo subsidiarias de tratamiento quirúrgico. Desde el inicio del estudio en julio de 2017 hasta febrero de 2018, los traumatólogos participantes en el estudio cambiaron el uso de la gasa estéril estándar para cubrir la herida quirúrgica tras su cierre por Aquacel Ag Extra<span class="elsevierStyleSup">®</span>, manteniendo el resto del protocolo pre- y posquirúrgico igual. Se comparan la tasa de complicaciones cutáneas en ambos grupos, tras un seguimiento de 3 meses.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El análisis estadístico no reflejó diferencias significativas entre ambos grupos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se necesitan ensayos clínicos aleatorizados para demostrar las ventajas teóricas de los apósitos impregnados con plata y su indicación en Traumatología.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Luque-Valenzuela M, Sánchez-Aguilera AJ, Martín-Vivaldi-Jiménez A, Jódar-Graus R, Prados-Olleta N. ¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag<span class="elsevierStyleSup">®</span>? Rev Esp Cir Ortop Traumatol. 2019;63:342–345.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0100" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sterile dressings<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>179 (76.8%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Silver-impregnated dressings<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>54 (23.2%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wound dehiscence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Skin necrosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (2.79%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Superficial infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (3.35%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (3.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Deep infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.12%)(<span class="elsevierStyleItalic">S. aureus</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (3.7%)(<span class="elsevierStyleItalic">S. aureus</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Delay in skin healing >3 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (1.68%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2117772.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Complications in both groups during the follow-up period.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sterile dressings<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>179 (76.8%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Silver-impregnated dressings<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>54 (23.2%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 [37–63] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.5 [39.75–62.25] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.428 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.860 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 (45.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (44.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 (54.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (55.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Smoking habit</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">168 (93.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 (88.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.236 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Diabetes mellitus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">159 (88.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (85.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.471 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Venous insufficiency</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">171 (95.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (98.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.689 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Glycaemia at admission</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">107 [94.25–125.75] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">106 [97–125] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.940 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Creatinine at admission</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 [0.67–0.89] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.81 [0.68–0.97] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.444 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Type of fracture (Weber Classification)</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.297 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (9.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">138 (77.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (68.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (12.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (14.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Delay before surgery</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 [1–4] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 [1–3] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.115 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Skin complications</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (10.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (7.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.560 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2117773.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Statistical analysis of independent variables analysed in the two groups.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 58123 ] ] 3 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc2.pdf" "ficheroTamanyo" => 960581 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complication rates following open reduction and internal fixation of ankle fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.F. SooHoo" 1 => "L. Krenek" 2 => "M.J. Eagan" 3 => "B. Gurbani" 4 => "C.Y. Ko" 5 => "D.S. Zingmond" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.H.00653" "Revista" => array:5 [ "tituloSerie" => "J Bone Jt Surg Am" "fecha" => "2009" "volumen" => "91" "paginaInicial" => "1042" "paginaFinal" => "1049" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Schepers" 1 => "M.R. de Vries" 2 => "E.M.M. van Lieshout" 3 => "M. van der Elst" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00264-012-1753-9" "Revista" => array:5 [ "tituloSerie" => "Int Orthop" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "489" "paginaFinal" => "494" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0115" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications in ankle fracture surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Ovaska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/17453674.2014.100227" "Revista" => array:6 [ "tituloSerie" => "Acta Orthop Suppl" "fecha" => "2015" "volumen" => "86" "paginaInicial" => "1" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26036608" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0120" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of fractures requiring inpatient care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Somersalo" 1 => "J. Paloneva" 2 => "H. Kautiainen" 3 => "E. Lönnroos" 4 => "M. Heinänen" 5 => "I. Kiviranta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/17453674.2014.908340" "Revista" => array:6 [ "tituloSerie" => "Acta Orthop" "fecha" => "2014" "volumen" => "85" "paginaInicial" => "525" "paginaFinal" => "530" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24694275" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0125" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "LEAP Study Group" "etal" => false "autores" => array:5 [ 0 => "A.N. Pollak" 1 => "A.L. Jones" 2 => "R.C. Castillo" 3 => "M.J. Bosse" 4 => "E.J. MacKenzie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.H.00984" "Revista" => array:5 [ "tituloSerie" => "J Bone Jt Surg Am" "fecha" => "2010" "volumen" => "92" "paginaInicial" => "7" "paginaFinal" => "15" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0130" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morbidity and readmission after open reduction and internal fixation of ankle fractures are associated with preoperative patient characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.A. Basques" 1 => "C.P. Miller" 2 => "N.S. Golinvaux" 3 => "D.D. Bohl" 4 => "J.N. Grauer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11999-014-4005-z" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2015" "volumen" => "473" "paginaInicial" => "1133" "paginaFinal" => "1139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25337977" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0135" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors affecting healing of ankle fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.B. Dodson" 1 => "A.J. Ross" 2 => "R.W. Mendicino" 3 => "A.R. Catanzariti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jfas.2012.10.013" "Revista" => array:5 [ "tituloSerie" => "J Foot Ankle Surg" "fecha" => "2013" "volumen" => "52" "paginaInicial" => "2" "paginaFinal" => "5" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0140" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is it worth discriminating against patients who smoke? A systematic literature review on the effects of tobacco use in foot and ankle surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.H. Kim" 1 => "S. Patel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jfas.2017.02.006" "Revista" => array:6 [ "tituloSerie" => "J Foot Ankle Surg" "fecha" => "2017" "volumen" => "56" "paginaInicial" => "594" "paginaFinal" => "599" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28476393" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0145" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical versus conservative interventions for treating ankle fractures in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.C. Donken" 1 => "H. Al-Khateeb" 2 => "M.H. Verhofstad" 3 => "C.J. van Laarhoven" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD008470.pub2" "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2012" "volumen" => "8" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0150" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of osteoporotic and neuropathic ankle fractures in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Hoogervorst" 1 => "C.V. Bergen" 2 => "M. van den Bekerom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13670-017-0196-y" "Revista" => array:7 [ "tituloSerie" => "Curr Geriatr Rep" "fecha" => "2017" "volumen" => "6" "paginaInicial" => "9" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28316904" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0264410X14005234" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0155" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The economic significance of orthopaedic infections" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Hackett" 1 => "A.C. Rothenberg" 2 => "A.F. Chen" 3 => "C. Gutowski" 4 => "D. Jaekel" 5 => "I.M. Tomek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5435/JAAOS-D-14-00394" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Orthop Surg" "fecha" => "2015" "volumen" => "23" "numero" => "Suppl." "paginaInicial" => "S1" "paginaFinal" => "S7" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0160" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Allegranzi" 1 => "P. Bischoff" 2 => "S. de Jonge" 3 => "N.Z. Kubilay" 4 => "B. Zayed" 5 => "S.M. Gomes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(16)30398-X" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "e276" "paginaFinal" => "e287" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27816413" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0165" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Allegranzi" 1 => "B. Zayed" 2 => "P. Bischoff" 3 => "N.Z. Kubilay" 4 => "S. de Jonge" 5 => "F. de Vries" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(16)30402-9" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "e288" "paginaFinal" => "e303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27816414" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0170" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do dressings prevent infection of closed primary wounds after surgery?" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Bluebelle Study Group" "etal" => false "autores" => array:1 [ 0 => "J. Blazeby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.i2270" "Revista" => array:4 [ "tituloSerie" => "BMJ" "fecha" => "2016" "volumen" => "24" "itemHostRev" => array:3 [ "pii" => "S0264410X15011688" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0175" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilization of silver hydrogel sheet dressing on postsurgical incisions: a pilot study in foot and ankle surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.M. Galli" 1 => "N.M. Protzman" 2 => "S.A. Brigido" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1938640013507108" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Spec" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "422" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24154992" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0180" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Silver-based dressings for the reduction of surgical site infection: review of current experience and recommendation for future studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.C. Abboud" 1 => "J.C. Settle" 2 => "T.B. Legare" 3 => "J.E. Marcet" 4 => "D.J. Barillo" 5 => "J.E. Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.burns.2014.09.011" "Revista" => array:7 [ "tituloSerie" => "Burns" "fecha" => "2014" "volumen" => "40" "numero" => "Suppl. 1" "paginaInicial" => "S30" "paginaFinal" => "S39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25418436" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0185" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dressings for the prevention of surgical site infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Dumville" 1 => "T.A. Gray" 2 => "C.J. Walter" 3 => "C.A. Sharp" 4 => "T. Page" 5 => "R. Macefield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD003091.pub4" "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2016" "volumen" => "12" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0190" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical site infection in elderly patients with hip fractures, silver-coated versus regular dressings: a randomised prospective trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Kadar" 1 => "G. Eisenberg" 2 => "E. Yahav" 3 => "M. Drexler" 4 => "M. Salai" 5 => "E.L. Steinberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12968/jowc.2015.24.10.441" "Revista" => array:6 [ "tituloSerie" => "J Wound Care" "fecha" => "2015" "volumen" => "24" "paginaInicial" => "441" "paginaFinal" => "442" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26488734" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0195" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Local modalities for preventing surgical site infections: an evidence-based review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A. Katarincic" 1 => "A. Fantry" 2 => "J.M. DePasse" 3 => "R. Feller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5435/JAAOS-D-16-00033" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Orthop Surg" "fecha" => "2018" "volumen" => "26" "paginaInicial" => "14" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29261553" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0200" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Silver-impregnated occlusive dressing reduces rates of acute periprosthetic joint infection after total joint arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.J. Grosso" 1 => "A. Berg" 2 => "S. LaRussa" 3 => "T. Murtaugh" 4 => "D.P. Trofa" 5 => "J.A. Geller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arth.2016.08.039" "Revista" => array:5 [ "tituloSerie" => "J Arthroplasty" "fecha" => "2017" "volumen" => "32" "paginaInicial" => "929" "paginaFinal" => "932" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack424271" "titulo" => "Acknowledgements" "texto" => "<p id="par0090" class="elsevierStylePara elsevierViewall">We wish to thank the nursing team and the Traumatologists that have participated for their collaboration, as well as thanking Manuela Expósito, a member of the Department of Statistics at the Hospital Universitario Virgen de las Nieves, for hers.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000006300000005/v1_201909060709/S1988885619300537/v1_201909060709/en/main.assets" "Apartado" => array:4 [ "identificador" => "7577" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000006300000005/v1_201909060709/S1988885619300537/v1_201909060709/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885619300537?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 0 | 5 |
| 2024 October | 11 | 3 | 14 |
| 2024 September | 26 | 5 | 31 |
| 2024 August | 28 | 1 | 29 |
| 2024 July | 18 | 6 | 24 |
| 2024 June | 24 | 4 | 28 |
| 2024 May | 16 | 3 | 19 |
| 2024 April | 14 | 0 | 14 |
| 2024 March | 23 | 2 | 25 |
| 2024 February | 37 | 11 | 48 |
| 2024 January | 26 | 7 | 33 |
| 2023 December | 27 | 13 | 40 |
| 2023 November | 31 | 3 | 34 |
| 2023 October | 29 | 5 | 34 |
| 2023 September | 24 | 6 | 30 |
| 2023 August | 13 | 2 | 15 |
| 2023 July | 6 | 5 | 11 |
| 2023 June | 20 | 12 | 32 |
| 2023 May | 15 | 3 | 18 |
| 2023 April | 11 | 5 | 16 |
| 2023 March | 9 | 2 | 11 |
| 2023 February | 9 | 9 | 18 |
| 2023 January | 9 | 2 | 11 |
| 2022 December | 28 | 5 | 33 |
| 2022 November | 17 | 7 | 24 |
| 2022 October | 13 | 6 | 19 |
| 2022 September | 16 | 9 | 25 |
| 2022 August | 20 | 10 | 30 |
| 2022 July | 14 | 15 | 29 |
| 2022 June | 23 | 11 | 34 |
| 2022 May | 23 | 14 | 37 |
| 2022 April | 30 | 7 | 37 |
| 2022 March | 14 | 6 | 20 |
| 2022 February | 13 | 4 | 17 |
| 2022 January | 10 | 5 | 15 |
| 2021 December | 12 | 9 | 21 |
| 2021 November | 18 | 10 | 28 |
| 2021 October | 14 | 10 | 24 |
| 2021 September | 16 | 10 | 26 |
| 2021 August | 12 | 1 | 13 |
| 2021 July | 23 | 3 | 26 |
| 2021 June | 21 | 6 | 27 |
| 2021 May | 10 | 2 | 12 |
| 2021 April | 44 | 9 | 53 |
| 2021 March | 20 | 11 | 31 |
| 2021 February | 9 | 4 | 13 |
| 2021 January | 8 | 3 | 11 |
| 2020 December | 1 | 0 | 1 |
Show all
