The value of quantitative histology in the diagnosis of fracture-related infection

Morgenstern, Mario; Na, Athanasou; Ferguson, Jamie; Metsemakers, Willem‐Jan; Atkins, BL; McNally, M

doi:10.1302/0301-620x.100b7.bjj-2018-0052.r1

Cited by 93 publications

(65 citation statements)

References 21 publications

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“…The diagnosis of early, acute fracture infections is often less problematic, with discharging wounds and virulent organisms, which are easier to culture 3 . In a recent study of FRI in cases more than four weeks from fracture, published after this search, a bimodal cut-off for the presence of PMN's provided encouraging results in reducing the number of cases in which the diagnosis was uncertain 31 .…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Tissue and Sonication Fluid Sampling for the Diagnosis of Fracture-Related Infection: A Systematic Review and Critical Appraisal

Onsea

Depypere

Govaert

et al. 2018

J. Bone Joint Infect.

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Introduction: Intraoperatively obtained peri-implant tissue cultures remain the standard for diagnosis of fracture-related infection (FRI), although culture-negative cases may complicate treatment decisions. This paper reviews the evidence on sonication fluid and tissue sampling for the diagnosis of FRI.Methods: A comprehensive search in Pubmed, Embase and Web-of-Science was carried out on April 5, 2018, to identify diagnostic validation studies regarding sonication fluid and tissue sampling for FRI.Results: Out of 2624 studies, nine fulfilled the predefined inclusion criteria. Five studies focused on sonication fluid culture, two on PCR and two on histopathology. One additional histopathology study was found after screening of reference lists. There is limited evidence that sonication fluid culture may be a useful adjunct to conventional tissue culture, but no strong evidence that it is superior or can replace tissue culture. Regarding molecular techniques and histopathology the evidence is even less clear. Overall, studies had variable 'gold standard' criteria for comparison and poorly reported culture methods.Conclusions: Scientific evidence on sonication fluid and tissue sampling, including culture, molecular techniques and histopathology for the diagnosis of FRI is scarce. It is imperative that laboratory protocols become standardized and uniform diagnostic criteria, as recently published in a consensus definition, be implemented.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Tissue and Sonication Fluid Sampling for the Diagnosis of Fracture-Related Infection: A Systematic Review and Critical Appraisal

Onsea

Depypere

Govaert

et al. 2018

J. Bone Joint Infect.

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“…Twenty-eight osteomyelitis patients and 21 controls were included in this study. The diagnosis of osteomyelitis was based on the following confirmatory criteria previously described (Morgenstern et al, 2018 ): supportive histopathological tests, fistula with communication to a bone or an implant, pathogens identified by culture from at least two separate sites in deep tissue, or an implant. Patients who had undergone internal fixation of fracture but finally healed were enrolled as controls.…”

Section: Methodsmentioning

confidence: 99%

Extracellular Vesicles: A Potential Biomarker for Quick Identification of Infectious Osteomyelitis

Deng

Wang

Liu

et al. 2020

Front. Cell. Infect. Microbiol.

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Effective management of infectious osteomyelitis relies on timely microorganism identification and appropriate antibiotic therapy. Extracellular vesicles (EVs) carry protein and genetic information accumulated rapidly in the circulation upon infection. Rat osteomyelitis models infected by Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli were established for the present study. Serum EVs were isolated 3 days after infection. The size and number of serum EVs from infected rats were significantly higher than those from controls. In addition, bacterial aggregation assay showed that the S. aureus and E. coli formed large aggregates in response to the stimulation of serum EVs from S. aureus-infected and E. coli-infected rats, respectively. Treatment of EVs-S. epidermidis led to large aggregates of S. epidermidis and E. coli, whereas stimulation of EVs-P. aeruginosa to large aggregates of S. aureus and P. aeruginosa. To evaluate the changes in EVs in osteomyelitis patients, 28 patients including 5 S. aureus ones and 21 controls were enrolled. Results showed that the size and number of serum EVs from S. aureus osteomyelitis patients were higher than those from controls. Further analysis using receiver operating characteristic curves revealed that only the particle size might be a potential diagnostic marker for osteomyelitis. Strikingly, serum EVs from S. aureus osteomyelitis patients induced significantly stronger aggregation of S. aureus and a cross-reaction with P. aeruginosa. Together, these findings indicate that the size and number of serum EVs may help in the diagnosis of potential infection and that EVsbacteria aggregation assay may be a quick test to identify infectious microorganisms for osteomyelitis patients.

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“…An infected segmental tibial bone defect was diagnosed according to the International Consensus criteria for fracture-related infections (FRI) [24,25]. Infection was present when at least one of the following criteria applied: (i) a draining sinus, (ii) an abscess or intraoperative purulence, (iii) significant growth of a microorganism from intraoperative tissue sampling (at least two or more positive sterile site cultures with indistinguishable organisms), and (iv) positive histopathology supportive of deep active infection.…”

Section: Infection Definitionmentioning

confidence: 99%

Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia

Sigmund

Ferguson

Govaert

et al. 2020

JCM

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This prospective study compared bifocal acute shortening and relengthening (ASR) with bone transport (BT) in a consecutive series of complex tibial infected non-unions and osteomyelitis, for the reconstruction of segmental defects created at the surgical resection of the infection. Patients with an infected tibial segmental defect (>2 cm) were eligible for inclusion. Patients were allocated to ASR or BT, using a standardized protocol, depending on defect size, the condition of soft tissues and the state of the fibula (intact or divided). We recorded the Weber–Cech classification, previous operations, external fixation time, external fixation index (EFI), follow-up duration, time to union, ASAMI bone and functional scores and complications. A total of 47 patients (ASR: 20 patients, BT: 27 patients) with a median follow-up of 37.9 months (range 16–128) were included. In the ASR group, the mean bone defect size measured 4.0 cm, and the mean frame time was 8.8 months. In the BT group, the mean bone defect size measured 5.9cm, and the mean frame time was 10.3 months. There was no statistically significant difference in the EFI between ASR and BT (2.0 and 1.8 months/cm, respectively) (p = 0.223). A total of 3/20 patients of the ASR and 15/27 of the BT group needed further unplanned surgery during Ilizarov treatment (p = 0.006). Docking site surgery was significantly more frequent in BT; 66.7%, versus ASL; 5.0% (p < 0.0001). The infection eradication rate was 100% in both groups at final follow-up. Final ASAMI functional rating scores and bone scores were similar in both groups. Segmental resection with the Ilizarov method is effective and safe for reconstruction of infected tibial defects, allowing the eradication of infection and high union rates. However, BT demonstrated a higher rate of unplanned surgeries, especially docking site revisions. Acute shortening and relengthening does not reduce the fixator index. Both techniques deliver good functional outcome after completion of treatment.

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The value of quantitative histology in the diagnosis of fracture-related infection

Cited by 93 publications

References 21 publications

Accuracy of Tissue and Sonication Fluid Sampling for the Diagnosis of Fracture-Related Infection: A Systematic Review and Critical Appraisal

Accuracy of Tissue and Sonication Fluid Sampling for the Diagnosis of Fracture-Related Infection: A Systematic Review and Critical Appraisal

Extracellular Vesicles: A Potential Biomarker for Quick Identification of Infectious Osteomyelitis

Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia

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