Infected hardware after surgical stabilization of rib fractures

Abstract

Background Surgical stabilization of rib fracture (SSRF) is increasingly used for treatment of rib fractures. There are few data on the incidence, risk factors, outcomes, and optimal management strategy for hardware infection in these patients. We aimed to develop and propose a management algorithm to help others treat this potentially morbid complication. Methods We retrospectively searched a prospectively collected rib fracture database for the records of all patients who underwent SSRF from August 2009 through March 2014 at our institution. We then analyzed for the subsequent development of hardware infection among these patients. Standard descriptive analyses were performed. Results Among 122 patients who underwent SSRF, most (73%) were men; the mean (SD) age was 59.5 (16.4) years, and median (interquartile range [IQR]) Injury Severity Score was 17 (13–22). The median number of rib fractures was 7 (5–9), and 48% of patients had flail chest. Mortality at 30 days was 0.8%. Five patients (4.1%) had a hardware infection on mean postoperative day 12.0 (6.6). Median Injury Severity Score (17 [13–42]) and hospital length of stay (9 [6–37] days) in these patients were similar to the values for those without infection (17 [13–22] and 9 [6–12] days, respectively). Patients with infection underwent a median (IQR) of 2 (2–3) additional operations, which included wound débridement (n=5), negative-pressure wound therapy (n=3), and antibiotic beads (n=4). Hardware was removed in 3 patients at 140, 190, and 192 days after index operation. Cultures grew only gram-positive organisms. No patients required reintervention after hardware removal, and all achieved bony union and were taking no narcotics or antibiotics at the latest follow-up. Conclusions Although uncommon, hardware infection after SSRF carries considerable morbidity. With the use of an aggressive multimodal management strategy, however, bony union and favorable long-term outcomes can be achieved. Level of Evidence Therapeutic study, level V.

Rib fixation: Who, What, When?

“…This is an uncommon complication but requires a multimodality approach. 24 Retained hemothorax or persistent air leak must be monitored with postoperative imaging.…”

Negative Pressure Wound Therapy Can Prevent Surgical Site Infections Following Sternal and Rib Fixation in Trauma Patients: Experience From a Single-Institution Cohort Study

“…Hardware infections can occur as distant as three and a half years after placement [3,16]. In our study, the only local infection occurred eight months after sternal fixation.…”

“…Many of these infections occur in trauma patients and can be attributed to traumatic wound contamination, transient tissue hypoperfusion from sepsis and shock, altered patient immune response, and the need for multiple procedures [2]. Wound infection after sternotomy occurs in 1%-5% and after surgical intervention for rib fractures in 2%-7% (range 0.5%-20%) of patients [3,4].…”

Successful Surgical Stabilization of Rib Fractures Despite Candida Colonization of the Mediastinum

“…Definitive diagnosis of mediastinitis typically requires imaging or clinical evidence of sternal wound breakdown, in addition to positive culture results and systemic signs of infection [5,6,8]. As described by Malani and associates [8], positive culture results, inflammation of the sternum, absence of other microorganisms, and clinical response to antifungal agents are all required for the diagnosis of C. albicans deep sternal wound infection.…”

“…(Ann Thorac Surg 2018;106:e121-3) Ó 2018 by The Society of Thoracic Surgeons S urgical stabilization of rib fractures (SSRF) in patients with flail chest has been shown to decrease length of stay, pain, need for mechanical ventilation, and mortality [1][2][3][4]. The risk of hardware infection after SSRF is between 0% and 10% in all patients [5]. To minimize this risk, severe pneumonia, pleural space infection, and mediastinal infection are considered contraindications to SSRF because of the risk of seeding the implanted hardware, which can result in a chronic infection and the need for hardware explantation.…”