Risk factors for deep infection in secondary intramedullary nailing after external fixation for open tibial fractures
Introduction
In managing severe open tibia fractures, many orthopaedic surgeons have been obliged to use an external fixator in order to gain initial bony and soft-tissue stability. However, external fixation itself has been associated with several problems, such as delayed unions, non-unions, malunions and ankle joint stiffness.18 For these reasons, external fixators may be converted to intramedullary nailing. This exchange has been associated with intramedullary infection, as previously reported.12, 13, 14
Our aim in designing this retrospective study was to investigate risk factors for deep infection in secondary intramedullary nailing after external fixation for open tibial fractures.
Section snippets
Clinical materials
We treated 46 open tibial fractures with secondary intramedullary nailing (IMN) after external fixation (EF) at the Department of Orthopaedic Surgery and Trauma Center, Kitasato University Hospital, between 1986 January and 2002 February. We retrospectively reviewed 42 patients excluding 4 patients treated with IMN after pinless of EF. Some of these cases were reported previously.25, 26
Thirty-five patients were male and seven patients were female. The mean patients’ age at the time of injury
Results
Seven of the 42 open tibia fractures developed deep infections. Two of these infections were caused by Staphylococcus aureus alone, two were caused by Pseudmonas aeruginosa alone, one was caused by Staphylococcus epidermidis alone, one was caused by gram negative rod and bacillus sp. and one was caused by Serratia sp., and Pseud. Aeruginosa.
Although all deep infections occurred in Gustilo type III (7/31), this was not statistically significant (p = 0.084). The relationship between deep infection
Discussion
To our knowledge, Karlström and Olerud12 documented the first experience with secondary IMN after external fixation for three open tibia fractures. They reported two deep infections after these procedures, and advised against IMN after EF. McGraw and Lim14 and Mauer et al.13 presented detailed descriptions of the problems associated with secondary IMN after external fixation. They also reported a high incidence of deep infection in secondary or delayed IMN after EF.
Various authors have
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Cited by (60)
Definitive fixation of open tibia fractures: Does reopening the traumatic wound increase complication rates?
2022, Journal of Clinical Orthopaedics and TraumaAO external fixator for definitive treatment of an open distal tibia fracture during the COVID-19 pandemic
2021, Fuss und SprunggelenkCitation Excerpt :The gold standard for the treatment of open fractures of the long bones consists of aggressive debridement, irrigation and temporary external fixation accompanied by antibiotic prophylaxis [1,2,6,7,9–11]. Subsequent removal of external fixation and definite fixation with intramedullary nailing or plating is generally recommended within 2 weeks to achieve better stability for bone healing and diminish the risk of infection [12,13]. However, under several circumstances this type of treatment may not be feasible, and external fixator has to be used as a definitive mode of fixation.
Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb
2019, Journal of Orthopaedic ScienceCitation Excerpt :Third, open fractures of the femur and tibia were analyzed simultaneously. Our infection rate was 9.4%, lower than those reported in previous studies [9,11,27], even though analyses included both femur and tibia. In addition, the number of patients was small and investigation was performed in single institution.
Incidence and risk factors associated with infection after intramedullary nailing of femoral and tibial diaphyseal fractures: Prospective study
2018, InjuryCitation Excerpt :The risk factors associated with these infections may include general SSI risk factors as well as those specifically related to fracture fixation [12]. Retrospective studies suggest that open fractures, previous use of external fixation, clinical instability in initial care and the need for soft-tissue reconstruction may be associated with the occurrence of infection after IMN, although no prospective studies have assessed these potential risk factors [10,13–16]. Thus, the objective of this study was to prospectively assess the incidence and potential risk factors related to the occurrence of infection following IMN for fixation of femoral and tibial diaphyseal fractures.