Infection after intramedullary nailing of femoral and tibial diaphyseal fractures
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Tipo de produção
article
Data de publicação
2023
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ISSN da Revista
Título do Volume
Editora
ELSEVIER SCI LTD
Citação
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, v.54, suppl.6, article ID 110821, 6p, 2023
Resumo
Purpose: Management of fracture-related infection (FRI) after intramedullary fixation (IF) is a challenge. The aim of the present study is to describe a series of 26 patients with FRI after IF and to evaluate factors possibly related to the outcome. Methods: Baseline variables were obtained at the time of IF: age, sex, body mass index, affected bone, open fracture, substance abuse, use of an external fixator, type of nail, reaming, soft-tissue reconstruction and surveillance culture result. After diagnosis of the infection, information was obtained about the time interval between IF and diagnosis and classification according to both the Willeneger and Roth and Makridis systems. Treatment modalities were grouped and analysed according to: use of antimicrobials, surgical debridement, nail removal or retention and spacer use. Cultures of bone or deep soft tissues were performed. Patients were followed up for 12 months, and outcomes (remission, relapse, death and loss of follow-up) were evaluated, as well as fracture consolidation. Results: Remission was observed in 42.3% of patients. There was no significant association between any baseline variable and outcome. There was a significant association between Makridis stage 2 classification and recurrence or death. Treatment strategy was not significantly associated with outcome, and 65.4% of cases had positive culture results, with Enterobacter cloacae as the predominant agent. Consolidation was observed in 81.8% of patients and was not significantly related to the outcome. Conclusion: There was a significant association between Makridis classification and the outcome. Consolidation rate was not associated with the outcome regarding the treatment of the infection.
Palavras-chave
Fracture fixation, Intramedullary, Surgical wound infection, Treatment outcome, Microbiology, Fracture healing
Referências
- Chen CE, 2003, J TRAUMA, V55, P338, DOI 10.1097/01.TA.0000035093.56096.3C
- Davis KA, 2005, EMERG INFECT DIS, V11, P1218, DOI 10.3201/1108.050103
- de Carvalho VC, 2012, BRAZ J INFECT DIS, V16, P63, DOI 10.1590/S1413-86702012000100006
- Hellebrekers P, 2017, J ORTHOP SURG RES, V12, DOI 10.1186/s13018-017-0535-x
- Lima AL, 2008, NEW ENGL J MED, V358, P2846
- Makridis Kostas G, 2013, Open Orthop J, V7, P219, DOI 10.2174/1874325001307010219
- Mauffrey C, 2019, INT ORTHOP, V43, P417, DOI 10.1007/s00264-018-3964-1
- Metsemakers WJ, 2018, INJURY, V49, P505, DOI 10.1016/j.injury.2017.08.040
- Metsemakers WJ, 2018, INJURY, V49, P511, DOI 10.1016/j.injury.2016.09.019
- Metsemakers WJ, 2020, ARCH ORTHOP TRAUM SU, V140, P1013, DOI 10.1007/s00402-019-03287-4
- Miller JM, 1999, Clinical microbiology procedures handbook-A Guide to specimen management in clinical microbiology, V2nd
- Oliveira PR, 2018, INJURY, V49, P1905, DOI 10.1016/j.injury.2018.07.024
- Oliveira Priscila Rosalba, 2016, Rev. bras. ortop., V51, P396, DOI 10.1016/j.rboe.2015.09.012
- Petrisor B, 2005, J ORTHOP TRAUMA, V19, P437, DOI 10.1097/01.bot.0000161542.93624.8d
- Pfang BG, 2019, J CLIN MED, V8, DOI 10.3390/jcm8020220
- Rao NL, 2011, PLAST RECONSTR SURG, V127, p177S, DOI 10.1097/PRS.0b013e3182001f0f
- Ribeiro Marta, 2012, Biomatter, V2, P176, DOI 10.4161/biom.22905
- Vieira GD, 2015, REV ASSOC MED BRAS, V61, P341, DOI 10.1590/1806-9282.61.04.341
- Whiting PS, 2019, J ORTHOP TRAUMA, V33, pE234, DOI 10.1097/BOT.0000000000001441