Fate of Patients With a “Surprise” Positive Culture After Nonunion Surgery

Olszewski, Dana; Streubel, Philipp N.; Stucken, Charlton; Ricci, William M.; Hoffmann, Martin; Jones, Clifford B.; Sietsema, Debra L.; Tornetta, Paul

doi:10.1097/bot.0000000000000417

Cited by 45 publications

(36 citation statements)

References 13 publications

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“…One retrospective multicentre study found 20% of nonunions treated in humans had positive intra-operative cultures at the time of definitive surgery with the absence of any signs of gross infection or preoperative symptoms. Of these, only 78% healed after the initial procedure, and 92% healed with subsequent procedures (33). Theoretically, avascular bone provides an ideal environment for bacterial growth, condyle of one case, limiting the surface area impacted by the graft.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2

Massie

Kapatkin

Fuller

et al. 2017

Vet Comp Orthop Traumatol

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SummaryObjectives: To report the use of compression resistant matrix (CRM) infused with recombinant human bone morphogenetic protein (rhBMP-2) prospectively in the healing of non union long-bone fractures in dogs.Methods: A longitudinal cohort of dogs that were presented with nonunion fractures were classified and treated with CRM soaked with rhBMP-2 and fracture fixation. They were followed with serial radiographs and evaluated for healing times and complications according to the time frame and definitions previously established for orthopaedic clinical cases.Results: Eleven nonunion fractures in nine dogs were included. Median healing time was 10 weeks (range: 7–20 weeks). Major perioperative complications due to bandage morbidity were encountered in two of 11 limbs and resolved. All other complications were minor. They occurred perioperatively in eight of 11 limbs. Minor follow-up complications included short-term in one of two limbs, mid-term in one of three, and long-term in four of five limbs. Nine limbs returned to full function and two limbs returned to acceptable function at the last follow-up.Clinical significance: Nonunion fractures given a poor prognosis via standard-of-care treatment were successfully repaired using CRM with rhBMP-2 accompanying fixation. These dogs, previously at high risk of failure, returned to full or acceptable function.

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Section: Radiographic Evaluationmentioning

confidence: 99%

Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2

Massie

Kapatkin

Fuller

et al. 2017

Vet Comp Orthop Traumatol

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“…Evaluating these clinical parameters is the first and foremost step in the diagnostic procedure for a nonunion patient with suspected infection. However, patients with typical clinical manifestations of infection are decreasing, while quiescent infections are rising in recent years [ 1 ]. Low virulence bacteria and “biofilm pathogens” surrounding the implant have been reported as the primary causes that induce indolent infection [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Use of Serum Inflammatory Markers for Preoperative Diagnosis of Infection in Patients with Nonunions

Wang

Yin

Quan

et al. 2017

BioMed Research International

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Purpose The aim of this study is to evaluate the effectiveness of laboratory serum tests in the diagnosis of infected nonunion. Methods Forty-two patients suspected of having infected nonunion were investigated in the study. The serum levels of white blood-cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6) were measured. A positive diagnosis of infection was made on the basis of the positive culture results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each test were calculated. Results The sensitivity and specificity of CRP both were higher than IL-6: 60.0% versus 57.1% and 85.7% versus 57.1%, respectively. With one, two, three, and four positive tests, the predicted probabilities of infection were 66.7%, 90.9%, 100%, and 100%, respectively, but the number of patients who had three or four positive tests was small. Conclusions The diagnostic utility of IL-6 is inferior to CRP and the finding conflicts with previous conclusions drawn from periprosthetic infections. Laboratory analysis of serum inflammatory markers alone is not an effective screening tool for patients suspected of having an infected nonunion.

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“…White blood cell (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) should be obtained, and their elevation, especially when combined, is a strong predictor of infection [7]. Additionally, intraoperative cultures should be obtained at the time of revision surgery even if there are no clinical signs of infection, as 20% of patients in a large multicenter series were shown to have positive cultures, with only 9% felt to be contaminants [12]. If infection is confirmed in the initial laboratory evaluation and surgical intervention is deemed necessary and safe, multiple treatment options exist.…”

Section: Nonunion Evaluationmentioning

confidence: 99%

Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients

Babcock

Kellam

2018

Advances in Orthopedics

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In the United States, more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidity and mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at risk of nonunion complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should be completed for all patients suspected of nonunion. Failed internal fixation of intracapsular hip fractures is typically treated with arthroplasty, while extracapsular proximal femur nonunions may be amenable to revision internal fixation or arthroplasty. While not a classic hip fracture, bisphosphate associated subtrochanteric femur fractures affect a similar patient population and are historically difficult to treat. Atypical subtrochanteric femur fractures are at increased risk of nonunion given the altered biologic environment secondary to bisphosphonate use; therefore adjuvant therapies may be beneficial in setting of revision fixation. Having a thorough understanding of nonunion risks, recognition, evaluation, and treatment is necessary for appropriate patient care.

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Fate of Patients With a “Surprise” Positive Culture After Nonunion Surgery

Abstract: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 45 publications

References 13 publications

Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2

Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2

Evaluating the Use of Serum Inflammatory Markers for Preoperative Diagnosis of Infection in Patients with Nonunions

Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients

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