Foot ankle trauma surgery Prevention of surgical site infections and patient reported outcome

In the first part of this thesis the incidence of surgical site infections is studied in different trauma surgical procedures. Surgical site infections are evaluated as a complication of syndesmotic screw removal and after surgically treated calcaneal fractures. Moreover, the effect of season of surgery on the number of surgical site infections is investigated. In the second part the influence of prophylactic antibiotics on surgical site infections in foot ankle trauma surgery is further explored. This includes variations in dose and the resulting measured concentrations of antibiotics in different parts of the body. Moreover, the protocol of a randomized controlled trial studying the effect of 2g of cefazolin on infections after implant removal is described. The final part focusses on patient reported outcome after foot ankle surgery. This sections shows that implant removal is not necessarily beneficial when it comes to functional outcome and quality of life. Combined with the relatively high rate of surgical site infections after implant removal this leads to the conclusion that the individual indication for these procedures should be very carefully outweighed. In addition to functional outcome, malpractice claims are also evaluated as a tool indicating patient reported outcome. This last chapter shows that expectation management of the outcomes of primarily elective procedures is very important to avoid misunderstandings and dissatisfied patients.