Infected Internal Fixation after Ankle Fractures—A Treatment Path

The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection: A Systematic Review and Critical Appraisal

“…Six cohort studies [ 31 – 36 ] and two case-control studies [ 30 , 37 ] were included in this systematic review. Four of the cohort studies had a prospective [ 31 , 34 – 36 ] and two a retrospective design [ 32 , 33 ], respectively. NPWT duration varied and was often not reported.…”

“…Average wound healing time was stated in days and reported in six papers. Four studies repeated microbial swabs at vacuum dressings changes and reported on the detection of any new pathogens during the course of treatment [ 30 , 32 , 34 , 36 ].…”

“…Additionally, Timmers et al (2009, n = 30) found 3 cases of clinical infection recurrence (10%), which was significantly lower compared to the control group with conventional dressings, with an average time to recurrence of 8 months [ 30 ]. In the study of Kollrack et al (2012, n = 7), patients who were treated with initial surgical debridement, followed by NPWT, were followed through standard radiographic scans after swabs were negative [ 34 ]. In one patient (14.3%), radiographic pseudoarthrosis was seen, due to nonunion of the medial malleolus after a trimalleolar dislocated ankle fracture.…”

“…In this rather small retrospective series, the mean number of vacuum dressing placements was 3.6 (range: 2-8), and the average total length of hospitalization was 3.6 months (range: 2-8). Kollrack et al (2012) and Tan et al (2011) defined end of treatment as the point at which a dry, clean wound was achieved, respectively, after a mean of 54.4 [ 34 ] and 9.2 [ 37 ] days. Diefenbeck et al (2011) performed 9.8 debridements on average, until eradication of infection.…”

“…The results of repeated microbial swabs taken at later vacuum dressing changes were reported in only four out of eight studies [ 30 , 32 , 34 , 36 ]. Initial swabs were taken before treatment during first surgical debridement, in all four studies.…”