Department of Orthopaedics and Trauma Surgery of Hospital Clínic of Barcelona, University of Barcelona, C/Villarroel 170, Barcelona 08036, Spain.
Injury. 2011 Feb;42(2):200-3. doi: 10.1016/j.injury.2010.09.006.
Prosthetic joint infection (PJI) after femoral neck fracture is associated with a higher mortality, morbidity and economic costs. Although is well known that the presence of a post surgical haematoma is associated with infection, in our knowledge there are no articles evaluating the contamination of the femoral neck fracture haematoma and the possible relationship with early postoperative PJI. The aim of our study was to evaluate the prevalence of positive cultures from haematoma in patients with femoral neck fracture and the relationship with early PJI.
A prospective observational study was performed. All patients who underwent hiphemiarthroplasty for a femoral neck fracture from April'08 to February'09 were included. Three samples were taken just after the arthrotomy, a tissue sample, a swab of haematoma and blood of haematoma inoculated into blood culture flasks. Patients received the standard prophylaxis.
A total of 109 patients were treated during this period in our center, 16 were excluded for mistakes during taking samples or for receiving extra antibiotic treatment after or before the surgery of the fracture. In 29 patients (31.2%) one or more intraoperative cultures were positive. Four patients developed an early PJI caused by Gram-negative bacilli (GNB) in all cases. The early PJI rate in the group of patients with negative intraopertive cultures was 3.1% while in the group with one or more positive cultures was 6.9% (p = 0.3). In 3 cases the haematoma was contaminated with a GNB. The PJI rate inpatients with intraoperative cultures positive for a GNB was 66.6% (2/3) while in the group of patients without a GNB the infection rate was 2.2% (2/89, p = 0.004, Fisher exact-test). Furthermore in these two patients the microorganism that caused the PJI was the same that had been isolated from the haematoma.
The haematoma in femoral neck fractures was contaminated in 31.2% of cases before surgery. The contamination of the haematoma with a GNB was associated with a higher risk of early postoperative PJI.
股骨颈骨折后假体关节感染（PJI）与更高的死亡率、发病率和经济成本相关。虽然众所周知手术后血肿的存在与感染相关，但据我们所知，目前尚无评估股骨颈骨折血肿污染与早期术后 PJI 之间可能关系的文章。我们的研究目的是评估股骨颈骨折患者血肿中阳性培养的发生率，以及其与早期 PJI 的关系。
进行了一项前瞻性观察性研究。纳入 2008 年 4 月至 2009 年 2 月期间因股骨颈骨折行髋关节半髋关节置换术的所有患者。在关节切开术后立即采集 3 个样本：组织样本、血肿拭子和血肿血液接种于血培养瓶中。所有患者均接受标准预防措施。
在此期间，我院共治疗了 109 例患者，因术中取样错误或骨折术后或术前接受额外抗生素治疗而排除 16 例。在 29 例（31.2%）患者中，一个或多个术中培养物呈阳性。所有病例均由革兰氏阴性菌（GNB）引起 4 例早期 PJI。术中培养阴性组的早期 PJI 发生率为 3.1%，而术中培养阳性组的早期 PJI 发生率为 6.9%（p=0.3）。在 3 例中，血肿被 GNB 污染。术中培养物 GNB 阳性的患者中 PJI 发生率为 66.6%（2/3），而无 GNB 的患者中感染率为 2.2%（2/89，p=0.004，Fisher 确切检验）。此外，在这两名患者中，导致 PJI 的微生物与从血肿中分离出的微生物相同。
术前股骨颈骨折血肿的污染率为 31.2%。GNB 污染血肿与术后早期 PJI 的风险增加相关。
