Infection rate in adult patients with open fractures treated at the emergency hospital and at the ULBRA university hospital in Canoas, Rio Grande do Sul, Brazil

Guerra, Marcelo Teodoro Ezequiel; Gregio, Fernando Machado; Bernardi, Adriane; Castro, Cyntia Cordeiro de

doi:10.1016/j.rboe.2017.08.012

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…In the current study, the percentage of early infections (first 7 days) was 7.4%, results that differ from those of other studies from the national literature, which found percentages of 13.24%, 18.80%, and 23.7% for open fractures in general (18)(19)(20) , and most infections were observed in open fractures classified as Gustilo and Anderson type III (18)(19)(20)(21)(22) . It is inferred that our results were lower than those observed in the literature due to the higher percentage of less severe fractures in the current study (42% of Gustilo and Anderson type II open fractures); additionally, most study were prospective, with follow-up duration longer than 6 weeks (18)(19)(20)(21)(22) . In the study with the highest percentage of infections (23.7%), it was found that this high percentage was associated with severity of soft tissue injuries and delayed orthopedic treatment (22) .…”

Section: Discussioncontrasting

confidence: 99%

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Epidemiological study of open fractures of the ankle and foot

et al. 2021

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Objective: To characterize the epidemiological profile of patients treated at a hospital service with diagnosis of open fracture of the ankle and foot. Methods: Retrospective, descriptive, epidemiological, observational study of open fractures of the ankle and foot selected by convenience sampling in a hospital service in São Paulo, state of São Paulo, Brazil, from March 1, 2017, to March 1, 2019, totaling 109 patients. Data collection was conducted for the analysis of variables included in patients’ medical records. Results: The medical records of 700 patients with open fractures were assessed. Of these patients, 13.2% (109 patients) had open fractures of the ankle and foot. There was a predominance of male young adults (70.8%) and of left lower limb fractures (51.85%). Most cases were classified as Gustilo and Anderson type II fractures (42.6%). Motorcycle accidents (44.45%) predominated, and students and professional motorcyclists were the most frequent occupations (37.04%). The most adopted stabilization method was osteosynthesis (internal fixation) (44.45%), and primary amputation was required in 3.7% of the cases. Conclusion: Male young adults were the most affected by fractures of the ankle and foot, and traffic accidents were the leading cause. Most patients had an educational attainment of complete elementary education. Most fractures were classified as Gustilo and Anderson type II. Greater severity was observed in patients with associated injuries in other body segments and who developed early complications during hospitalization. Level of Evidence IV; Prognostic Studies; Case Series.

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Section: Discussioncontrasting

confidence: 99%

“…In order to minimize the risk for infection, timely treatment is performed with complete debridement, in which all foreign bodies and contaminated tissues, or those with suspected avascularization, are systematically removed, and death spaces and hematomas are minimized (13,(17)(18)(19)(20)(21)(22) .…”

Section: Discussionmentioning

confidence: 99%

Epidemiological study of open fractures of the ankle and foot

et al. 2021

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“…Blonna et al reported an infection rate of 4% out of 452 proximal humeral fractures and Ovaska et al identified 5% of 1923 consecutive ankle fractures to be infected 17 , 18 . One study carried out in Brazil found an infection rate of 13.24%, examining 142 patients with open fractures at various anatomical locations, whereas another one reported 18.8% infections in 133 patients with open fractures 19 , 20 . Additionally, a review on open femoral shaft fractures treated with intramedullary nailing estimated an infection rate of 6%, whereas another review reported infection rates in the range of 0.9–11.6% comparing outcomes of open tibial fractures 21 , 22 .…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of fracture-related infections in Germany

Walter

Rupp

Lang

et al. 2021

Sci Rep

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The epidemiology of fracture-related infection (FRI) is unknown, which makes it difficult to estimate future demands and evaluate progress in infection prevention. Therefore, we aimed to determine the nationwide burden’s development over the last decade as a function of age group and gender. FRI prevalence as a function of age group and gender was quantified based on annual ICD-10 diagnosis codes from German medical institutions between 2008 through 2018, provided by the Federal Statistical Office of Germany (Destatis). The prevalence of FRI increased by 0.28 from 8.4 cases per 100,000 inhabitants to 10.7 cases per 100,000 inhabitants between 2008 and 2018. The proportion of fractures resulting in FRI increased from 1.05 to 1.23%. Gender distribution was equal. Patients aged 60–69 years and 70–79 years comprised the largest internal proportion with 20.2% and 20.7%, respectively, whereby prevalence increased with age group. A trend towards more diagnoses in older patients was observed with a growth rate of 0.63 for patients older than 90 years. Increasing rates of fracture-related infection especially in older patients indicate an upcoming challenge for stakeholders in health care systems. Newly emerging treatment strategies, prevention methods and interdisciplinary approaches are strongly required.

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“…The treatment of critical size bone defects resulting from trauma or posttraumatic osteomyelitis is still very challenging for the orthopedic surgeon and has major socio-economic consequences [3,19,20]. S. aureus is the most common bacterium in bone infection after open fractures [10,21,22]. Moreover, S. aureus infection is an established and well-investigated animal model to study osteomyelitis [4,23,24].…”

Section: Discussionmentioning

confidence: 99%

A new sequential animal model for infection-related non-unions with segmental bone defect

Helbig

Guehring

Titze

et al. 2020

BMC Musculoskelet Disord

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Background: The treatment of fracture-related infections (FRI) is still a challenge for orthopedic surgeons. The prevalence of FRI is particularly high in open fractures with extensive soft-tissue damage. This study aimed to develop a new two-step animal model for non-unions with segmental bone defects, which could be used to evaluate new innovative bone substitutes to improve the therapeutic options in humans with FRI and bone defects. Methods: After randomization to infected or non-infected groups, 30 Sprague-Dawley rats underwent a transverse osteotomy of the mid-shaft femur with a 5 mm defect. Additionally, the periosteum at the fracture zone was cauterized at both sides. After intramedullary inoculation with 10 3 CFU Staphylococcus aureus (infected group) or PBS (non-infected group), a fracture stabilization was done by intramedullary K-wires. After 5 weeks, the bone healing process was evaluated, and revision surgery was performed in order to obtain increased bone healing. The initial K-wires were removed, and debridement of the osteotomy-gap was done followed by a more stable reosteosynthesis with an angle-stable plate. After further 8 weeks all rats were euthanized and the bone consolidation was tested biomechanically and the callus formation quantitatively by micro-CT analysis. Results: We developed and presented a new two-stage non-union animal model through a targeted S. aureus infection. After 5 weeks, all animals showed a non-union irrespective of assignment to the infected and noninfected group. Lane and Sandhu score showed a higher callus formation in the infected group. In all infected animals, the inoculated S. aureus strain was detected in the revision surgery. The second surgery did not improve bone healing, as shown by the Lane Sandhu score and in the μ-CT analysis. Similarly, biomechanical testing showed in both groups a significantly lower maximum torque as compared to the contralateral side (p < 0.0001). Conclusions: We were able to successfully develop a new two-stage non-union animal model, which reflects a genuine clinical situation of an infection-related non-union model with segmental bone defects. This model could be used to evaluate various therapeutic anti-infectious and osteoinductive strategies in FRIs.

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Infection rate in adult patients with open fractures treated at the emergency hospital and at the ULBRA university hospital in Canoas, Rio Grande do Sul, Brazil

Cited by 12 publications

References 17 publications

Epidemiological study of open fractures of the ankle and foot

Epidemiological study of open fractures of the ankle and foot

The epidemiology of fracture-related infections in Germany

A new sequential animal model for infection-related non-unions with segmental bone defect

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