Fracture Related Infections and Their Risk Factors for Treatment Failure—A Major Trauma Centre Perspective

Abstract

Fracture related infections (FRI) are debilitating and costly complications of musculoskeletal trauma surgery that can result in permanent functional loss or amputation. Surgical treatment can be unsuccessful, and it is necessary to determine the predictive variables associated with FRI treatment failure, allowing one to optimise them prior to treatment and identify patients at higher risk. The clinical database at a major trauma centre was retrospectively reviewed between January 2015 and January 2021. FRI treatment failure was defined by infection recurrence or amputation. A univariable logistic regression analysis was performed, followed by a multivariable regression analysis for significant outcomes between groups on univariable analysis, to determine risk factors for treatment failure. In total, 102 patients were identified with a FRI (35 open, 67 closed fractures). FRI treatment failure occurred in 24 patients (23.5%). Risk factors determined by our multivariate logistic regression model were obesity (OR 2.522; 95% CI, 0.259–4.816; p = 0.006), Gustilo Anderson type 3c (OR 4.683; 95% CI, 2.037–9.784; p = 0.004), and implant retention (OR 2.818; 95% CI, 1.588–7.928; p = 0.041). Given that FRI treatment in 24 patients (23.5%) ended up in failure, future management need to take into account the predictive variables analysed in this study, redirect efforts to improve management and incorporate adjuvant technologies for patients at higher risk of failure, and implement a multidisciplinary team approach to optimise risk factors such as diabetes and obesity.

Infection after surgical implant generation network (SIGN) nailing in treatment of long bone shaft fractures in Ethiopia: analysis of a 4-year results

“…We had analyzed 311 cases by taking age, sex, nature of fracture, pattern of fracture, mechanism of injury, follow-up in weeks, nail type, reduction technique and presence or absence of infection as predictors of clinical outcome and in our study we found that the prevalence infection among patients who had long bone fractures and treated with SIGN nailing was 4.2%. This finding is higher compared with a study conducted in UK which showed that the overall fractured related infection rate was 1.16% [32]. This might be due to setup difference; developing versus developed countries.…”

High rate of undetected infections in failed osteosynthesis of pertrochanteric fractures

“…Moreover, it is comparable with the 10%-11% reported on PJIs. [36][37][38][39] Both of those patients with polymicrobial infections were obese, which is a documented risk factor for presenting polymicrobial infections and for FRI treatment failure. 40 The main limitation of this study is related to its design.…”

Preparation and In Vitro Osteogenic Evaluation of Biomimetic Hybrid Nanocomposite Scaffolds Based on Gelatin/Plasma Rich in Growth Factors (PRGF) and Lithium-Doped 45s5 Bioactive Glass Nanoparticles

“…3 a). As far as mentioned above, High-energy traumas may cause open fractures that may lead to fracture-related infections (FRI) [ 40 , 41 ]. Also, it has been reported that the vast majority of the cases of bone infections are due to different types of Staphylococcus aureus as a gram-positive bacteria [ 83 , 84 ].…”

“…There can be permanent functional loss or amputation from fracture-related infections (FRIs). Additionally, open flaps can cause sepsis as a serious life-threatening consequence in severe cases [ 40 , 41 ]. Also, infections can deteriorate the bone healing process and delay it.…”