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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 11 - 11
24 Nov 2023
Sliepen J Buijs M Wouthuyzen-Bakker M Depypere M Rentenaar R De Vries J Onsea J Metsemakers W Govaert G IJpma F
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Aims

Fracture-Related Infection (FRI) is a severe complication caused by microbial infection of bone. It is imperative to gain more insight into the potentials and limitations of Debridement, Antibiotics and Implant Retention (DAIR) to improve future FRI treatment. The aims of this study were to: 1) determine how time to surgery affects the success rate of DAIR procedures of the lower leg performed within 12 weeks after the initial fracture fixation operation and 2) evaluate whether appropriate systemic antimicrobial therapy affects the success rate of a DAIR procedure.

Methods

This multinational retrospective cohort study included patients of at least 18-years of age who developed an FRI of the lower leg within 12 weeks after the initial fracture fixation operation, between January 1st 2015 to July 1st 2020. DAIR success was defined by the absence of recurrence of infection, preservation of the affected limb and retention of implants during the initial treatment. The antimicrobial regimen was considered appropriate if the pathogen(s) was susceptible to the given treatment at the correct dose as per guideline. Logistic regression modelling was used to assess factors that could contribute to the DAIR success rate.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 13 - 13
24 Nov 2023
Sliepen J Hoekstra H Onsea J Bessems L Depypere M Herteleer M Sermon A Nijs S Vranckx J Metsemakers W
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Aim

The number of operatively treated clavicle fractures has increased over the past decades. Consequently, this has led to an increase in secondary procedures required to treat complications such as fracture-related infection (FRI). The primary objective of this study was to assess the clinical and functional outcome of patients treated for FRI of the clavicle. The secondary objectives were to evaluate the healthcare costs and propose a standardized protocol for the surgical management of this complication.

Method

All patients with a clavicle fracture who underwent open reduction and internal fixation (ORIF) between 1 January 2015 and 1 March 2022 were retrospectively evaluated.

This study included patients with an FRI who were diagnosed and treated according to the recommendations of a multidisciplinary team at the University Hospitals Leuven, Belgium.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 84 - 84
1 Oct 2022
Sliepen J Corrigan R Dudareva M Wouthuyzen-Bakker M Rentenaar R Atkins B Hietbrink F Govaert G McNally M Ijpma F
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Background

Fracture-related infection (FRI) is treated by adequate debridement, lavage, fracture stabilization (if indicated), adequate soft tissue coverage and systemic antimicrobial therapy. Additional administration of local antibiotics (LA), placed directly in the surgical field, is thought to be beneficial for successful eradication of infection.

Aims

1) To evaluate the effect of local antibiotics on outcome in patients with FRI. 2) To evaluate whether bacterial resistance to the implanted local antibiotics influences its efficacy.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 10 - 10
1 Oct 2022
Sweere V Sliepen J Haidari S Depypere M Mertens M IJpma F Metsemakers W Govaert G
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Aim

Fracture-related infection (FRI) is one of the most serious complications in orthopedic trauma surgery [1]. The role of Negative Pressure Wound Therapy (NPWT) remains controversial in the management pathway of FRI [2]. Currently, as scientific evidence is lacking, most recommendations for NPWT with respect to the treatment of FRI are based on expert opinion [3]. The aim of this study was to assess the influence of NPWT and its duration on recurrence of infection in operatively treated FRI patients.

Methods

This is a retrospective cohort study based on the FRI database of three Level 1 Trauma Centres. To be included, patients had to be at least 16 years of age and needed to be surgically treated for FRI between January 1st 2015 and September 1st 2020. Included patients were subdivided in either the NPWT group, or in the control group, when no NPWT had been applied. To avoid confounding, patients were excluded if they (also) underwent NPWT prior to the FRI diagnosis. The relation between the duration of NPWT during FRI treatment and the recurrence rate of infection was analyzed using a multivariable logistic regression model.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 14 - 14
1 Oct 2022
Sliepen J Depypere M Onsea J Debaveye Y Govaert G Ijpma F Zimmerli W Metsemakers W
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Purpose

Fracture-related infection (FRI) is an important complication related to orthopaedic trauma. Although the scientific interest with respect to the diagnosis and treatment of FRI is increasing, data on the microbiological epidemiology remains limited. Therefore, the primary aim of this study was to evaluate the microbiological epidemiology related to FRI, including the association with clinical symptoms and antimicrobial susceptibility data. The secondary aim was to analyze whether there was a relationship between the time to onset of infection and the microbiological etiology of FRI.

Methods

Over a five-year period, FRI patients treated at the University Hospitals of Leuven, Belgium, were retrospectively included. The microbiological etiology and antimicrobial susceptibility data were analyzed. Patients were classified as having an early (<2 weeks after implantation), delayed (2–10 weeks) or late-onset (> 10 weeks) FRI.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 13 - 13
1 Oct 2022
Corrigan R Dudareva M Sliepen J Wouthuyzen M Rentenaar R Ijpma F Hietbrink F Atkins B Govaert G McNally M
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Aim

Fracture related infection (FRI) is classically defined as early (0–2 weeks), delayed (3–10 weeks) or late (>10 weeks). Treatment strategies reflect this, particularly with debridement and implant retention (DAIR), but there is little evidence to support this. This multinational study clarified the relationship between pathogens isolated and time from injury.

Methods

All confirmed FRI cases, managed surgically, at three hospitals were included. Data were analyzed on patient demographics, time from injury and pathogens isolated. Patients who underwent DAIR were also analyzed separately.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 11 - 11
1 Dec 2021
Corrigan R Sliepen J Rentenaar R Hietbrink F IJpma F Atkins B Govaert G McNally M Wouthuyzen-Bakker M
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Aim

This study investigated the effect of the choice of antibiotic regime on outcome of patients treated for fracture-related infection (FRI) at 3 centres, in the UK and the Netherlands between 2015 and 2019.

Method

All patients with FRI, confirmed by the FRI Consensus Definition1 and treated surgically, were included. Data were collected on patient characteristics, microbial cultures, antibiograms, empiric and definitive systemic antibiotic regimes and local antibiotic use. All patients were followed up for at least one year. The primary outcome was eradication of infection. The chosen antibiotic regimes were compared to the recent guidelines from the FRI Consensus Group2, to assess the correlation with outcome.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 14 - 14
1 Dec 2021
McNally M Corrigan R Sliepen J Hietbrink F IJpma F Wouthuyzen-Bakker M Rentenaar R Atkins B Govaert G
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Aim

This study investigated the management and clinical outcomes of patients treated for confirmed fracture-related infection (FRI) at 3 centres, in the UK and the Netherlands between 2015 and 2019.

Method

All patients with FRI, confirmed by the FRI Consensus Definition1 and treated surgically, were included. Data were collected on patient characteristics, time from injury to FRI surgery, soft tissue reconstruction, type of stabilization and use of local antibiotics. All patients were followed up for at least one year. The rates of eradication of infection and union were assessed. The associations between treatment methods, time from injury and outcomes were determined.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 10 - 10
1 Dec 2021
Buijs M van den Kieboom J Sliepen J Wever K Hietbrink F Leenen L IJpma F Govaert G
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Aim

Early fracture-related infections (FRIs) are a common entity in hospitals treating trauma patients. It is important to be aware of the consequences of FRI in order to be able to counsel patients about the expected course of their disease. Therefore, the aims of this study were to evaluate the recurrence rate, to establish the number of secondary surgical procedures needed to gain control of the initial infection, and to identify predictors for recurrence in patients with early FRI.

Method

A retrospective multicentre cohort study was conducted in two level 1 trauma centres. All patients between January 1st 2015 to July 1st 2020 with confirmed FRI with an onset of <6 weeks after initial fracture fixation were included. Recorded data included patient demographics, trauma mechanism, clinical and laboratory findings, surgical procedure, microbiology, and follow-up. Univariate and multivariate logistic regression analyses were performed to assess predictors for recurrent FRI.