Complications Following Limb-Threatening Lower Extremity Trauma

Harris, Anthony M.; Althausen, Peter L.; Kellam, James F; Bosse, Michael J.; Castillo, Renan C.

doi:10.1097/bot.0b013e31818e43dd

Cited by 276 publications

(141 citation statements)

References 14 publications

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“…Infection after traumatic and combat-related amputation is relatively common with reported rates as high as 34% [4,9,13,14]. The frequency in our study cohort was similar at 31% and was not found to be different than control subjects without imaging.…”

Section: Discussionsupporting

confidence: 53%

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Polfer

Hoyt

Senchak

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background In the acute postoperative period, fluid collections are common in lower extremity amputations. Whether these fluid collections increase the risk of infection is unknown. Questions/purposes The purposes of this study were to determine (1) the percentage of patients who develop postoperative fluid collections in posttraumatic amputations and the natural course of the collection; (2) whether patients who develop these collections are at increased risk for infection; and to ask (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present?Methods We performed a review of all 300 patients injured in combat operations who sustained at least one major lower extremity amputation (at or proximal to the tibiotalar joint) and were treated definitively at our institution between March 2005 and April 2009. We segregated the groups based on whether cross-sectional imaging was performed less than 3 months (early group) after closure, greater than 3 months (late group) after closure, or not at all (control group, baseline frequency of infection). Our primary study cohort where those patients with a fluid collection in the first three months. The clinical course was reviewed and the primary outcome was a return to the operating room for irrigation and débridement with positive cultures. For those patients with cross-sectional imaging, we also collected objective clinical parameters within 24 hours of the scan (white blood cell count, maximum temperature, presence of bacteremia, tachycardia, oxygen desaturation), extremity examination (presence of erythema, warmth, and/or drainage), and characteristics of the fluid collections seen (size of the fluid collection, Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Section: Discussionsupporting

confidence: 53%

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Polfer

Hoyt

Senchak

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Consequently, those last three patients had more complications, more operative procedures, and longer hospital LOS than those patients treated with urgent amputation, as is usually the case [14]. Regarding these postoperative complications, the majority of them were related to wound infection, (grade III of the Clavien-Dindo classification), also reported by other studies [5].…”

Section: Limitations Of the Studysupporting

confidence: 55%

Overall Anatomic Severity and Prognosis in Patients Presenting with, or Requiring a Major Lower Limb Amputation from Civilian Trauma

Sánchez-Arteaga¹,

Lusilla-López²,

Zarain-Obrador³

et al. 2018

Trauma Cases Rev

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“…Despite these efforts, non-union and infection are still common complications with rates of up to 32% and 23%, respectively, reported in civilian severe lower extremity injuries. 1 Similarly, infection is the most common cause of delayed amputation in combat-related open tibial fractures. 2 Bacteria produce biofilm that is protective against microbial agents, 3 and the antibiotic concentrations needed to eliminate these sessile colonies found in biofilms can be more than 500 times those required to kill planktonic bacteria.…”

mentioning

confidence: 99%

Effect of various concentrations of antibiotics on osteogenic cell viability and activity

Rathbone

Cross

Brown

et al. 2011

Journal Orthopaedic Research

290

224

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Infection is a common complication of open fractures. Systemic antibiotics often cause adverse events before eradication of infected bone occurs. The local delivery of antibiotics and the use of implants that deliver both growth factors and antimicrobials are ways to circumvent systemic toxicity while decreasing infection and to reach extremely high levels required to treat bacterial biofilms. When choosing an antibiotic for a local delivery system, one should consider the effect that the antibiotic has on cell viability and osteogenic activity. To address this concern, osteoblasts were treated with 21 different antibiotics over 8 concentrations from 0 to 5,000 mg/ml. Osteoblast deoxyribonucleic acid content and alkaline phosphatase activity (ALP) were measured to determine cell number and osteogenic activity, respectively. Antibiotics that caused the greatest decrement include rifampin, minocycline, doxycycline, nafcillin, penicillin, ciprofloxacin, colistin methanesulfonate, and gentamicin; their cell number and ALP were significantly less than control at drug concentrations 200 mg/ ml. Conversely, amikacin, tobramycin, and vancomycin were the least cytotoxic and did not appreciably affect cell number and ALP until very high concentrations were used. This comprehensive evaluation of numerous antibiotics' effects on osteoblast viability and activity will enable clinicians and researchers to choose the optimal antibiotic for treatment of infection and maintenance of healthy host bone. ß

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Complications Following Limb-Threatening Lower Extremity Trauma

Cited by 276 publications

References 14 publications

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Overall Anatomic Severity and Prognosis in Patients Presenting with, or Requiring a Major Lower Limb Amputation from Civilian Trauma

Effect of various concentrations of antibiotics on osteogenic cell viability and activity

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