To classify Fracture-related Infection (FRI) allowing comparison of clinical studies and to guide decision-making around the main surgical treatment concepts. An international group of FRI experts met in Lisbon, June 2022 and proposed a new FRI classification. A core group met during the EBJIS Meeting in Graz, 2022 and on-line, to determine the preconditions, purpose, primary factors for inclusion, format and the detailed description of the elements of an FRI Classification.Aim
Method
Duration of perioperative antimicrobial prophylaxis (PAP) remains controversial in prevention of fracture-related infection (FRI) – with rates up to 30% - in open fracture (OF) management. Objectives were to investigate the impact of the PAP duration exclusively in or related to long bone OF trauma patients and the influence of augmented renal clearance (ARC), a known phenomenon in trauma patients, as PAP consists of predominantly renally eliminated antibiotics. Trauma patients with operatively treated OF, admitted between January 2003 and January 2017 at the University Hospitals Leuven, were retrospectively evaluated. FRI was defined following the criteria of the consensus definition of FRI. A logistic regression model was conducted with FRI as outcome. Results were considered statistically significant when p< 0.05.Aim
Method
Infection rates after management of open fractures are still high. Existing guidelines regarding prevention of this complication are inhomogeneous. A survey directed to orthopaedic trauma surgeons worldwide aims to give an overview of current practices in the management of open fractures. An international group of trauma surgeons and infection specialists with experience in the field of musculoskeletal infections developed a questionnaire that was distributed via email to all AOTrauma members worldwide. Descriptive statistical analysis was performed.Aim
Method
Infection of the ankle joint is a serious problem that can have a debilitating outcome if not identified and treated appropriately. The purpose of this retrospective study is to present epidemiologic data aimed at better characterising the clinical diagnosis of septic ankle guiding empiric therapy. All admissions to Los Angeles County+USC Medical Center between 1996 and 2005 were screened to identify patients with ankle infection, shown by a synovial WBC count >
50,000, frank purulence in the joint, or positive synovial culture. Forty-two patients (33 male, 9 female) with a mean age of 44.8 (23 to 67 years) were identified. Twelve out of forty-two patients had indwelling hardware and were excluded from further analysis. Of the 30 patients with hematogenous septic ankle arthritis, 87% reported ankle pain, 70% ankle swelling, and 50% demonstrated decreased range of motion at the ankle joint. Cultures grew Staphylococcus aureus (43%), streptococci (30%), and gram-negative rods (7%). Twenty-three percent of cases were polymicrobial; no cases of Neisseria gonorrhea were identified. There were 3 cases of M. tuberculosis, and 1 case each of Coccidioides immitis and Aspergillus sp. Forty-four percent of the Staphylococcus aureus were methicillin-resistant (MRSA); no change was observed in prevalence of resistant organisms over time. Only 48% had an elevated WBC count; C-reactive protein and ESR were elevated in 100% of patients. Adjacent osteomyelitis was found in 30% of patients. Open irrigation and debridement was performed in 73% of cases; five patients required multiple surgical procedures and 1 amputation. Septic ankle arthritis presents non-specifically; a high index of suspicion is essential to ensure prompt identification and treatment. Empiric antibiotic therapy should cover Staphylococcus aureus (including MRSA) and streptococcus. Patients should be evaluated for adjacent osteomyelitis.
Drug injection often results in soft tissue infections of the upper extremity. The purpose of this study was to determine the distinct bacteriologic features of soft tissue abscesses in injecting drug abusers in order to provide guidelines for optimal empiric antibiotic therapy. Admissions to the musculoskeletal infection ward at our institution from 1993 to 2005 were screened to identify patients with a history of injecting illicit drugs and a diagnosis of a soft tissue abscess. Eight hundred fifty-five patients met these criteria and were included in this retrospective study. There were 638 male and 217 female patients with a mean age of 41.5 years (18 to 75 years). In the 694 patients with positive cultures the most common organism was Staphylococcus aureus, identified in 359 patients (52%). A progressive increase in the prevalence of ORSA was observed; ORSA comprised 5% of Staphylococcus aureus infections in 1999, 50% in 2001, 56% in 2003, and 82% in 2005. Microaerophilic Streptococcus was present in 37% of culture-positive cases and other anaerobes in 10%. Infections were monomicrobial in 366 of 694 patients (53%) and polymicrobial in 328 of 694 patients (47%). Staphylococcus aureus is the most common pathogen in soft tissue abscesses in injecting drug abusers with an increasing proportion of ORSA. In addition to surgical decompression of abscesses, broad-spectrum empiric antibiotic therapy may be necessary.
Intramedullary infection is a challenging problem and management usually includes removal of the infected hardware and reaming of the medullary canal. The purpose of this study is to describe a new technique for canal debridement and evaluate its efficacy in the treatment of posttraumatic osteomyelitis of the tibia and femur. This retrospective study included 11 patients (10 male and 1 female, mean age: 42 years) with posttraumatic osteomyelitis of the tibia (n=8) or femur (n=3). Surgical treatment consisted of debridement, implant removal, and reaming of the medullary canal with the RIA (Reamer Irrigator Aspirator) device. All procedures were performed by a single surgeon with a standardised technique. Reaming of the canal was performed with one pass of the RIA. Following reaming, the RIA was used for irrigation of the medullary canal with 10 liters of fluid. At a mean follow-up time of 9 months (6 to 13 months) there was no recurrence of osteomyelitis. Complications included one partial loss of a flap, one refracture of a tibia following an auto versus pedestrian accident, and external fixator pin tract infections in one patient. The RIA device allows for reaming under simultaneous irrigation and aspiration, which may minimise the residual amount of infected tissue in the medullary canal. The disposable reamer head is always sharp, in contrast to standard reamers, which may reduce the thermal effects of reaming on the adjacent bone. In addition, the RIA allows delivery of fluid throughout the length of the medullary canal, thus facilitating irrigation. The RIA device is useful alternative for debridement of intramedullary infections of the tibia and femur.
The purpose of this study is to present the preliminary results after treatment of shoulder sepsis with prolonged implantation of an antibiotic-loaded cement spacer in a selected group of compromised patients. The current study included 11 patients (9 males and 2 females) with a mean age of 64 years (range: 36–79 years). All patients were treated with radical debridement, implantation of an antibiotic-impregnated polymethylmethacrylate spacer, and 6 weeks of antibiotic therapy. The subjective complaints, range of motion of the shoulder, functional outcome (mini-DASH score), and radiographic findings were evaluated. Nine patients at a mean follow-up time of 21 months (range: 13–18 months) were free of infection with pain relief and adequate shoulder function for activities of daily living. Radiographic evaluation revealed no loosening or fracture of the spacer and no progressive degenerative changes involving the glenoid. Prolonged implantation of the spacer may be a useful alternative in selected patients with poor general condition.
1) the ulnar lip or trough of the radiocapitellar joint in pronation and 2) the posterior or midportion of the MRPUJ.