From the Department of Orthopaedic Trauma Services (T.M.L.), Mission Hospital, Asheville, North Carolina; Department of Orthopaedic Surgery and Sports Medicine (T.B.A., D.J.P., D.B.), Harborview Medical Center, University of Washington, Seattle, Washington.
J Trauma Acute Care Surg. 2013 Oct;75(4):664-8. doi: 10.1097/TA.0b013e31829a0a94.
We hypothesized that internal fixation procedures performed on trauma intensive care unit (ICU) patients with systemic infections, some also febrile, would be at increased risk for deep infection.
A total of 128 patients (mean age, 37.4 years; mean Injury Severity Score [ISS], 34.7) admitted to the ICU with 179 femur or tibia fractures developed systemic infections. Systemic infections included sepsis, pneumonia, urinary tract infections, abdominal infections, and wound infections remote to the fracture. Of the fractures, 33 open and 146 closed underwent 150 intramedullary and 29 plate fixation procedures. Data were gathered regarding antibiotic use, systemic infection timing in relation to the date of fixation, and whether fever (>38.2°C) was present within 24 hours of fixation. Patients were followed up for a mean of 491 days.
Twenty-eight procedures were performed a mean of 4.7 days after the diagnosis of a systemic infection, and 151 were performed a mean of 9.3 days before the diagnosis. Forty-five procedures were performed in patients who were febrile within 24 hours. Of the 179 procedures, 10 (5.6%) developed a deep infection. Four patients' implant infection was potentially hematogenously seeded with the same organism as their systemic infection. Neither the timing of the systemic infection in relation to the fixation procedure nor the presence of fever within 24 hours of fixation, days of preoperative antibiotics, location of the fracture, type of fixation (intramedullary nail vs. plate fixation), or type of systemic infection was significantly associated with the development of an infection. The only significant risk factor for developing an orthopedic infection was an open fracture (p < 0.001).
Internal fixation performed in ICU patients with fever or in close conjunction to the diagnosis of systemic infection led to a 5.6% infection rate, which compares favorably with historic infection rates for fixation of open or closed tibia and femur fractures.
Therapeutic, level IV.
我们假设，在创伤重症监护病房（ICU）中对患有全身感染（部分患者还伴有发热）的患者进行内固定手术，其深部感染的风险会增加。
共有 128 例（平均年龄 37.4 岁；平均损伤严重程度评分 [ISS] 34.7）因 179 例股骨或胫骨骨折在 ICU 中出现全身感染。全身感染包括败血症、肺炎、尿路感染、腹部感染和骨折部位以外的伤口感染。其中 33 例为开放性骨折，146 例为闭合性骨折，分别进行了 150 例髓内和 29 例钢板内固定手术。收集了抗生素使用、固定日期与全身感染时间的关系以及固定后 24 小时内是否发热（>38.2°C）等数据。患者平均随访 491 天。
28 例手术在诊断出全身感染后平均 4.7 天进行，151 例手术在诊断前平均 9.3 天进行。45 例手术在固定后 24 小时内发热的患者中进行。在 179 例手术中，10 例（5.6%）发生深部感染。4 名患者的植入物感染可能是由与全身感染相同的病原体血行播散所致。全身感染与固定手术的时间关系以及固定后 24 小时内发热、术前抗生素使用天数、骨折部位、固定类型（髓内钉与钢板固定）或全身感染类型均与感染的发生无显著相关性。发生骨科感染的唯一显著危险因素是开放性骨折（p<0.001）。
在 ICU 中对发热患者或在全身感染诊断密切相关的患者进行内固定治疗，其感染率为 5.6%，与开放性或闭合性胫骨和股骨骨折固定的历史感染率相比具有优势。
治疗性，IV 级。
