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

Abstract

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.

Global research characteristics and trends of infection after spinal implant surgery: a bibliometric analysis

“…Cluster 1 encompassed the topic of diagnosis and treatment of IASIS. The C-reactive protein (CRP) blood test was highlighted in group 1, and it is also commonly used as a first-line diagnostic method for other orthopedic implant-associated infections, such as PJI and fracturerelated infection (34)(35)(36). However, for low-virulence microorganisms, there was a high occurrence of CRP in the normal range (37,38).…”

A bibliometric analysis of clinical research on fracture-related infection

“…The diagnosis and treatment of postoperative infections are often complex. They require a multidisciplinary approach (i.e., surgeons, infectious disease physicians, and clinical pharmacists), often result in additional surgeries and a long duration of antibiotic therapy [ 7 , 8 ]. The health care system costs are immense.…”