Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study

Bosch, P. Girard; Kieboom, Janna van den; Plate, Joost D J; IJpma, Frank F. A.; Houwert, Roderick M.; Huisman, Albert; Hietbrink, Falco; Leenen, Luke P. H.; Govaert, Geertje A M

doi:10.7150/jbji.26492

Cited by 21 publications

(26 citation statements)

References 47 publications

(48 reference statements)

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“…Therefore conventional radiographs are still the most utilized diagnostic imaging modality for most physicians when considering the diagnosis of Brodie's abscess. In line with previous reports 18,19 Staphylococcus aureus is the dominant pathogen found. Only in six cases culture showed MRSA to be present.…”

Section: Discussionsupporting

confidence: 92%

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Brodie's Abscess: A Systematic Review of Reported Cases

Naald

Smeeing

Houwert

et al. 2019

J. Bone Joint Infect.

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Introduction: Brodie's abscess is a form of osteomyelitis. Since its first appearance in the medical literature in 1832, numerous cases have been described. The aim of this article is to provide the first comprehensive overview of published cases of Brodie's abscess, and to describe diagnostic methods, therapeutic consequences and outcomes.Methods: According to PRISMA guidelines a systematic review of the literature was performed. All published data in English or Dutch were considered for inclusion with no limitations on publication date. Data was extracted on demography, duration of symptoms, signs of inflammation, diagnostic imaging, causative agent, treatment and follow-up.Results: A total of 70 articles were included, reporting on a total of 407 patients, mostly young (median age 17) males (male:female ratio 2.1:1). The median duration of symptoms before diagnosis was 12 weeks (SD 26). Mostly consisting of pain (98%) and/or swelling (53%). 84% of all patients were afebrile, and less than 50% had elevated serum inflammation markers. Diagnosis was made with a combination of imaging modalities: plain X-ray in 96%, MRI (16%) and CT-scan (8%). Treatment consisted of surgery in 94% of the cases, in conjunction with long term antibiotics in 77%. Staphylococcus aureus was the pathogen most often found in the culture (67,3%). Outcome was generally reported as favorable. Recurrence was reported in 15,6% of the cases requiring further intervention. Two cases developed permanent disability.Conclusion: Brodie's abscess has an insidious onset as systemic inflammatory signs and symptoms were often not found. Treatment consisted mostly of surgery followed by antibiotics (77%) or only surgery (17%) and outcomes were generally reported as favourable.

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Section: Discussionsupporting

confidence: 92%

“…The limited benefit of serum inflammation markers in fracture related infections has been studied before 18 and our findings in Brodie's abscess are comparable.…”

Section: Discussionsupporting

confidence: 70%

Brodie's Abscess: A Systematic Review of Reported Cases

Naald

Smeeing

Houwert

et al. 2019

J. Bone Joint Infect.

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“…The pattern observed in our study was similar to another study analysing laboratory markers in nonunions [ 24 ]. Another study also observed a limited value of serum inflammatory markers for diagnosing fracture-related infections [ 25 ], with a sensitivity of 38% (using a threshold of only 5.0 mg/l); the AUC was nearly identical to our study.…”

Section: Discussionsupporting

confidence: 87%

The value of conventional radiographs for diagnosing internal fixation-associated infection

Renz

Trampuž

et al. 2021

BMC Musculoskelet Disord

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Background The aim of the study is to assess the diagnostic value of preoperative conventional radiographs for diagnosing infection associated with internal fixation devices. Methods We prospectively collected data of patients undergoing removal of internal fixation devices for any reason. Infection was diagnosed in case of purulence, sinus tract, positive histopathology and/or positive peri-implant tissue or sonication fluid culture. In radiographs radiolucent lines, implant breakage or displacement, or periosteal reaction were assessed. White blood cell count (WBC) and serum C-reactive protein (CRP) were determined at admission. Results We included 421 surgeries in 380 patients (median age 53.6 years, range 11–98 years), mainly indicated for infection (24.9%), nonunion (20.0%) and symptomatic implants (13.5%). Radiologic signs of infection included radiolucent lines (11.4%); implant breakage (12.4%) or displacement (10.7%); and periosteal reaction (7.1%). Infection was confirmed in 116 cases (27.6%). Only radiolucent lines (OR = 1.86 [95%CI: 1.00–3.38]) and periosteal reaction (OR = 2.48 [95%CI: 1.17–5.26]) were associated with infection, with a low sensitivity (16.4 and 12.1%, respectively), and high specificity (90.5 and 94.8%, respectively). Preoperative WBC and CRP had a sensitivity of 23.0 and 35.3%, and specificity of 91.7 and 89.5%, respectively. Conclusions Radiological signs suggestive of infection were uncommon. Radiolucency and periosteal reaction were associated with infection, though with low sensitivity.

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“… 10 In recent studies of infected fractures and non-unions, blood markers had very limited predictive value. 11 , 12 They cannot be used to confirm or exclude an infection.…”

Section: Blood Biomarkersmentioning

confidence: 99%

Definition and diagnosis of fracture-related infection

et al. 2020

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Fracture-related infection (FRI) is common and often diagnosed late. Accurate diagnosis is the beginning of effective treatment. Diagnosis can be difficult, particularly when there are no outward signs of infection. The new FRI definition, together with clear protocols for nuclear imaging, microbiological culture and histological analysis, should allow much better study design and a clearer understanding of infected fractures. In recent years, there has been a new focus on defining FRI and avoiding non-specific, poorly targeted treatment. Previous studies on FRI have often failed to define infection precisely and so are of limited value. This review highlights the essential principles of making the diagnosis and how clinical signs, serum tests, imaging, microbiology, molecular biology and histology all contribute to the diagnostic pathway. Cite this article: EFORT Open Rev 2020;5:614-619. DOI: 10.1302/2058-5241.5.190072

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Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study

Cited by 21 publications

References 47 publications

Brodie's Abscess: A Systematic Review of Reported Cases

Brodie's Abscess: A Systematic Review of Reported Cases

The value of conventional radiographs for diagnosing internal fixation-associated infection

Definition and diagnosis of fracture-related infection

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