Two-stage treatment in patients with patients with high-energy femoral fractures does not lead to an increase in deep infectious complications: a propensity score analysis

Abstract

PurposeIn patients following severe trauma sometimes the physiological condition or soft tissue status may not allow definitive fixation of a femoral fracture. In these patients, an external fixator can be placed to temporarily stabilise the fracture, after which definitive fixation can be performed in a second procedure. The aim of this study was to compare the postoperative wound infection and union rates of patients treated with direct intramedullary nailing (IMN) and patients treated with the ‘two-stage treatment’.MethodsAll patients with high-energy femoral fractures treated with IMN between 2000 and 2016 in a single Level 1 trauma centre were eligible. Electronic charts were reviewed for patient and surgical characteristics; furthermore, the development of complications was noted. A propensity score analysis was performed to assess the attributed risk of the external fixator on the development of postoperative wound infections.ResultsA total of 149 patients were included in this study; 93 underwent direct IMN and 56 underwent the two-stage treatment. Patients who underwent two-stage treatment were more severely injured, reflected by lower EMV and higher ISS on admission. Patients in the two-stage treatment group had a significant higher risk of postoperative wound infections (OR: 4.698, 95% CI: 1.203–18.339) but not a higher risk on deep postoperative wound infections (OR 2.345, 95% CI: 0.439–12.540). Union rate did not differ between the two groups (94% vs 94% NS).ConclusionsThe two-stage treatment is a safe treatment option in patients with a high-energy femoral fracture in terms of postoperative wound infections. Union rates are also comparable between the two treatment groups.

Early and Mid-Term Outcomes of Nonsurgical Management of Femoral Shaft Fractures with Associated Multiple Injuries in School-Age Children

“…The major challenge and drawback of non-surgical management is the unequal length of lower limbs in our setting. It is the most common complication of femoral shaft fractures in children, mainly manifested as overgrowth [29]. Most of these cases develop limb length discrepancy in the first two years after the fracture, especially in the first three months; subsequently, it tends to disappear gradually within two years after the fracture.…”

Incidence and Risk Factors for Surgical Site Infection after Femoral Neck Fracture Surgery: An Observational Cohort Study of 2218 Patients

“…The injury mechanism (high energy) has been verified as an independent risk factor of SSI [ 48 ], which was reconfirmed in the present study. First, the high-energy injuries meant the resultant more damaged skin, the fractured bone itself, and even open wounds, which allowed microbial easy to colonize and contaminate to give rise to SSI [ 43 , 49 ]. Moreover, our data showed that the operative time in the high-energy group was approximately twice that of the low-energy group, which might have prolonged the exposure of wounds to the air, resulting in the increased risk of infection [ 50 ].…”

External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients

“…In addition, patients with severe soft tissue injuries (Gustilo III) were not indicated for intramedullary nailing due to a high risk of infection [ 11 , 12 ]. For high-energy hip trauma, Dingemans et al [ 32 ] compared direct intramedullary nailing and two-stage treatment, concluding that two-stage treatment is a safe treatment option in young patients in terms of post-surgery wound infections and union rates. Our results are similar and support this opinion.…”