Risk Factors for Infection After Intramedullary Nailing of Open Tibial Shaft Fractures in Low- and Middle-Income Countries

Abstract

Objectives: (1) To determine the infection rate after fixation of open tibial shaft fractures using the Surgical Implant Generation Network (SIGN) intramedullary nail in low- and middle-income countries (LMICs) and (2) to identify risk factors for infection. Design: Prospective cohort study using an international online database. Setting: Multiple hospitals in LMICs worldwide. Patients/Participants: A total of 1061 open tibia fractures treated with the SIGN nail in LMICs between March 2000 and February 2013. Intervention: Intravenous antibiotic administration, surgical debridement, and definitive intramedullary nailing within 14 days of injury. Main Outcome Measurements: Deep or superficial infection at follow-up, implant breakage/loosening, angular deformity >10 degrees, repeat surgery, radiographic union, weight bearing, and ability to kneel. Results: The overall infection rate was 11.9%. Infection rates by the Gustilo and Anderson classification were type 1: 5.1%, type II: 12.6%, type IIIa: 12.5%, type IIIb: 29.1%, and type IIIc: 16.7% (P = 0.001 between groups). Patients who developed infection had a longer mean time from injury to definitive surgery (4.7 vs. 3.9 days, P = 0.03) and from injury to wound closure (13.7 vs. 3.6 days, P < 0.001). Distal fractures had a higher infection rate than midshaft fractures (13.3% vs. 8.2%, P = 0.03). Infection rates were not associated with time from injury to initial debridement, time from injury to initial antibiotic administration, or total duration of antibiotics. Conclusions: Open tibia fractures can be managed effectively using the SIGN intramedullary nail in LMICs with an overall infection rate of 11.9%. Risk factors for infection identified include more severe soft-tissue injury, delayed nailing, delayed wound closure, and distal fracture location. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Induced Membrane Technique for the Management of Segmental Tibial Defect or Nonunion: A Systematic Review and Meta-Analysis

“…However, perioperative infection is multifactorial. Whiting et al had identified severe soft tissue injury as a risk factor for infection in patients who sustained open tibial shaft fractures treated by intramedullary nailing [29]. Longer bone defect might be associated with more severe compromise of soft tissue, and thereby had higher chances of infection.…”

Comparison of clinical efficacy of suprapatellar and infrapatellar intramedullary nailing in treating tibial shaft fractures

“…After a tibial fracture, the weight bearing capacity of the affected limb is lost and, if not treated in time, it seriously affects the quality of life of patients with pain and limping among other symptoms. 1 , 2 The most common treatment for tibial fracture is intramedullary nail fixation to promote the recovery of the affected limb. Intramedullary nailing techniques include the suprapatellar and infrapatellar approaches.…”

Study to Determine the Outcomes of Closed Tibial Shaft Fractures Treated with Reamed Inter Locking Nails

“…The tibia is the most common long broken bone in the body due to its anatomical location and susceptibility to injury [1][2] . Treatment has always been a challenge for orthopedic surgeons due to the specific local anatomical feature, the high degree of fragmentation and the accompanying soft tissue trauma, which contributes to the high complication rate after open surgery [3][4] . The different treatment options include closed reduction and plaster of Paris, open reduction and internal fixation with plates and screws, external fixation, and intramedullary devices.…”