Management of femoral non-union with post-traumatic bone defect using second-generation PRECICE® nail - A case report

Lu, Victor; Zhang, James; Krkovič, Matija

doi:10.1016/j.tcr.2021.100585

Cited by 2 publications

(2 citation statements)

References 25 publications

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“…Soft tissue damage and vascular compromise encourage microbial infiltration which upsets normal bone healing [3]. Furthermore, a positive feedback mechanism leads to a vicious cycle of biomechanical instability at the fracture site and FRI, as described by Perren's concept of strain theory and fracture healing [5,6]. Fracture instability leads to impaired neovascularistaion; together with ongoing osteolysis and soft tissue damage, this encourages microbial proliferation and undermines the host immune response.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Patel

et al. 2022

Diagnostics

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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.

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Section: Introductionmentioning

confidence: 99%

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

Zhang

Patel

et al. 2022

Diagnostics

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show abstract

Section: Introductionmentioning

confidence: 99%

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

Zhang

Zhou

et al. 2023

Bone Joint J

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Fracture related infections (FRI) are debilitating complications of musculoskeletal trauma surgery that can result in permanent functional loss or amputation. This study aims to determine risk factors associated with FRI treatment failure, allowing clinicians to optimise them prior to treatment and identify patients at higher risk.A major trauma centre database was retrospectively reviewed over a six-year period. Of the 102 patients identified with a FRI (66 male, 36 female), 29.4% (n=30) had acute infections (onset <6 weeks post-injury), 34.3% (n=35) had an open fracture. Open fractures were classified using Gustilo-Anderson (GA) classification (type 2:n=6, type 3A:n=16, type 3B:n=10, type 3C:n=3). Patients with periprosthetic infections of the hip and knee joint, those without prior fracture fixation, soft tissue infections, diabetic foot ulcers, pressure sore infections, patients who died within one month of injury, <12 months follow-up were excluded.FRI treatment failure was defined as either infection recurrence, non-union, or amputation. Lifestyle, clinical, and intra-operative data were documented via retrospective review of medical records. Factors with a P-value of p<0.05 in univariate analysis were included in a stepwise multivariate logistic regression model.FRI treatment failure was encountered in 35.3% (n=36). The most common FRI site was the femoral shaft (16.7%; n=17), and 15.7% (n=16) presented with signs of systemic sepsis. 20.6% (n=21) had recurrent infection, 9.8% (n=10) had non-union, and 4.9% (n=5) required an amputation. The mean age at injury was 49.71 years old. Regarding cardiovascular risk factors, 37 patients were current smokers (36.3%), 31 patients were diabetics (30.4%), and 32 patients (31.4%) were obese (BMI≥30.0). Average follow-up time was 2.37 (range: 1.04-5.14) years. Risk factors for FRI treatment failure were BMI>30, GA type 3c, and implant retention.Given that FRI treatment in 35.3% (36/102) ended up in failure, clinicians need to take into account the predictive variables analysed in this study, and implement a multidisciplinary team approach to optimise these factors. This study could aid clinicians to redirect efforts to improve high risk patient management, and prompt future studies to trial adjuvant technologies for patients at higher risk of failure.

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Management of femoral non-union with post-traumatic bone defect using second-generation PRECICE® nail - A case report

Cited by 2 publications

References 25 publications

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

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

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

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