Infection rates following internal fixation of open and closed tibia fractures with Intra medullary inter locking nail-observational cohort study

Abstract

Background: Diaphysial fractures of tibia are most common fractures of lower extremity, this has been in raise due to increased Road Traffic Accidents (RTA). Locked intra medullary nailing currently is considered the treatment of choice. Surgical site infection following internal fixation is a fearful complication as affecting the quality of life. The primary objectives of this study were to determine the rate of infection within one year of surgery and to describe the distribution of infections by location and time of diagnosis for tibia fractures in our study. Methods: We conducted a prospective cohort study. Patients who presented with an open or closed tibia shaft fracture treated with Inter Locking Nail (ILN) at our hospitals were invited to participate in the study. Participants attended follow-up visits at 3, 6, and 12 months post-surgery, where they were assessed for presence of infection at surgical site. Results: 213 participants were included in the study and 199 participants completed the 12 month follow-up. The overall rates of infection within 12 months of surgery was 11% (22 participants).The incidence of infection was higher in open fractures (17.1%) (12 infections) as compared to closed fractures (7.8%) (10 infections) with p<0.0001.There were 15 (68%) deep infections and 7 (32%) superficial infections. There were 8 (37%) early infections, 5 (23%) delayed infections, and 9 (40%) late infections. Almost all participants received prophylactic antibiotics before surgery of which (92.9%) of open fractures and (84.5%) of patients with closed fractures received antibiotic within 60 minutes of incision and rest received more than an hour prior to surgery. All cases were given post-operative IV antibiotics (100%). The antibiotics were given for an average of 5.5±2 days in open fractures and 4±1 days in closed fractures. Conclusions: The observed infection rates in our study were much higher compared to others similar studies. The duration of prophylactic antibiotic use was longer than standard practice. It raises concern for need to look in to best practices of peri operative patient management to maintain low Infection rates and also to be vigilant about the potential development of antibiotic resistant microbes within our settings. Postoperative antibiotics for longer durations doesn't seem to reduce the infection rates as per our study.