Treatment Approach for Infection of Healed Fractures After Internal Fixation.

OBJECTIVE

To review the efficacy of a treatment approach for patients with infection and colonized implants after open reduction and internal fixation of fractures.

DESIGN

Retrospective case series.

SETTING

Level one trauma center.

PATIENTS

Twenty patients were treated for wound infection with colonized implants after open reduction and internal fixation.

INTERVENTION

Surgical debridement, removal of implants, and a short postoperative oral antibiotic course.

MAIN OUTCOME MEASUREMENT

The course of patients after surgical debridement and removal of implants, including culture results, antibiotic administration, and presence of recurrent clinical infection and radiographic union.

RESULTS

Twenty patients had clinical presentations, including skin breakdown, serous drainage, purulent drainage and/or exposed implants, most commonly of the tibia (15 of 20). Mean time from index procedure to debridement with implant removal was 19.7 months. At the time of debridement and implant removal, 18 of 20 (90%) patients had a positive intraoperative culture (16 routine cultures and 2 broth cultures). The most common bacteria were Enterobacter cloacae (5/17) and methicillin-sensitive Staphylococcus aureus (4/17). All patients had soft tissue healing without signs of recurrent infection after mean follow up of 40 months after implant removal.

CONCLUSIONS

Surgical debridement with implant removal plus a short oral antibiotic course is effective to resolve wound infection with a colonized implant in the setting of healed fracture after internal fixation.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.