Vanderbilt University Medical Center, Nashville, TN 37232, USA.
J Bone Joint Surg Am. 2010 Apr;92(4):823-8. doi: 10.2106/JBJS.I.00470.
The development of a deep wound infection in the presence of hardware after open reduction and internal fixation presents a clinical dilemma, and there is scant literature to aid in decision-making. The purpose of the present study was to determine the prevalence of osseous union with maintenance of hardware after the development of postoperative infection within six weeks after internal fixation of a fracture.
The present study included 121 patients from three level-I trauma centers, retrospectively identified from billing and trauma registries, in whom 123 postoperative wound infections with positive intraoperative cultures had developed within six weeks after internal fixation of acute fractures. The incidence of fracture union without hardware removal was calculated, and the parameters that predicted success or failure were evaluated.
Eighty-six patients (eighty-seven fractures; 71%) had fracture union with operative débridement, retention of hardware, and culture-specific antibiotic treatment and suppression. Predictors of treatment failure were open fracture (p = 0.03) and the presence of an intramedullary nail (p = 0.01). Several variables were not significant but trended toward an association with failure, including smoking, infection with Pseudomonas species, and involvement of the femur, tibia, ankle, or foot.
Deep infection after internal fixation of a fracture can be treated successfully with operative débridement, antibiotic suppression, and retention of hardware until fracture union occurs. These results may be improved by patient selection based on certain risk factors and the specific bacteria and implants involved.
开放性复位内固定术后出现内置物深部感染是临床面临的难题，目前相关文献较少，难以提供决策依据。本研究旨在明确骨折内固定术后 6 周内发生感染后，维持内置物是否能实现骨愈合。
本研究纳入了三家一级创伤中心的 121 例患者，这些患者均通过计费和创伤登记处进行了回顾性识别，他们在急性骨折内固定术后 6 周内发生了 123 例术后伤口感染，且培养结果为阳性。计算了不取出内固定物骨折愈合的发生率，并评估了预测成功或失败的参数。
86 例患者（87 处骨折；71%）接受了清创术、保留内置物和针对特定病原体的抗生素治疗及抑制治疗，骨折愈合。治疗失败的预测因素包括开放性骨折（p = 0.03）和髓内钉的存在（p = 0.01）。虽然一些变量无统计学意义，但与失败有一定关联趋势，包括吸烟、铜绿假单胞菌感染以及股骨、胫骨、踝关节或足部受累。
骨折内固定术后深部感染可通过清创术、抗生素抑制治疗和保留内置物直至骨折愈合来成功治疗。通过基于特定风险因素和涉及的特定细菌和植入物对患者进行选择，可能会改善这些结果。
