Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
J Orthop Trauma. 2023 Jun 1;37(6):276-281. doi: 10.1097/BOT.0000000000002569.
To apply the recently developed fracture-related infection criteria to patients presenting for repair of fracture nonunion and determine the incidence and associated organisms of occult infection in these patients.
Retrospective study.
Tertiary referral trauma center.
Patients presenting with fracture nonunion after operative intervention.
Demographic variables, injury characteristics, culture results, and physical examination and laboratory values at the time of presentation.
A total of 270 nonunion patients were identified. Sixty-eight percent (n = 184) had no clinical or laboratory signs of infection at presentation before nonunion repair. After operative intervention, 7% of these clinically negative patients (n = 12/184) had positive intraoperative cultures indicating occult infection. The most common organisms causing occult infection were low-virulence coagulase-negative Staphylococcu s (83%) and Cutibacterium acnes (17%). Thirty-two percent of patients (n = 86/270) presented with clinical and/or laboratory signs of infection at presentation before nonunion repair, with 19% of these patients (n = 16/86) having negative cultures. The most common organisms in this group of patients with positive clinical signs and intraoperative cultures were methicillin-resistant Staphylococcus Aureus (21%) and gram-negative rods (29%). Patients with nonunion of the tibia were significantly more likely to have high-virulence organism culture results ( P < 0.001).
Based on this analysis, occult infection occurs in 7% of patients presenting with nonunion and no clinical or laboratory signs of infection. We recommend that all patients should be carefully evaluated for infection with intraoperative cultures regardless of presentation. Organisms associated with occult infection at the time of nonunion repair were almost exclusively of low virulence ( CoNS and C. Acnes ) and were more likely to present in the upper extremity. Patients with nonunion of the tibia were more likely to have infection secondary to high-virulence organisms and demonstrate clinical or laboratory signs of infection at the time of presentation.
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
应用最近开发的骨折相关感染标准来评估接受骨折不愈合修复的患者，并确定这些患者隐匿性感染的发生率和相关病原体。
回顾性研究。
三级转诊创伤中心。
接受手术干预后出现骨折不愈合的患者。
人口统计学变量、损伤特征、培养结果以及就诊时的体格检查和实验室值。
共确定了 270 例骨折不愈合患者。68%（n=184）在接受不愈合修复前就诊时无临床或实验室感染迹象。在接受手术干预后，这 184 例临床阴性患者中有 7%（n=12/184）的术中培养呈阳性，表明存在隐匿性感染。导致隐匿性感染的最常见病原体是低毒力凝固酶阴性葡萄球菌（83%）和痤疮丙酸杆菌（17%）。32%（n=270）的患者在接受不愈合修复前就诊时存在临床和/或实验室感染迹象，其中 19%（n=16/86）的培养结果为阴性。在这组具有阳性临床体征和术中培养的患者中，最常见的病原体是耐甲氧西林金黄色葡萄球菌（21%）和革兰氏阴性杆菌（29%）。胫骨骨折不愈合的患者更有可能出现高毒力病原体培养结果（P<0.001）。
根据本分析，7%的骨折不愈合患者就诊时无临床或实验室感染迹象，但存在隐匿性感染。我们建议所有患者均应进行仔细评估，包括术中培养，以确定是否存在感染，无论其就诊时的表现如何。在接受不愈合修复时，隐匿性感染相关病原体几乎完全为低毒力病原体（凝固酶阴性葡萄球菌和痤疮丙酸杆菌），更有可能发生在上肢。胫骨骨折不愈合的患者更有可能因高毒力病原体引起感染，并在就诊时表现出临床或实验室感染迹象。
诊断 IV 级。有关证据等级的完整描述，请参见作者说明。
