Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Surg Infect (Larchmt). 2023 Jun;24(5):433-439. doi: 10.1089/sur.2022.347. Epub 2023 May 4.
Fracture-related infection (FRI) sometimes occurs with peri-prosthetic femoral fracture (PPF) treatment. Fracture-related infection often leads to multiple re-operations, possible non-union, a decreased clinical function, and long-term antibiotic treatment. In this multicenter study, we aimed to clarify the incidence of FRI, the causative organisms of wound infection, and the risk factors associated with post-operative infection for PPF. Among 197 patients diagnosed with peri-prosthetic femoral fracture who received surgical treatment in 11 institutions (named the TRON group) from 2010 to 2019, 163 patients were included as subjects. Thirty-four patients were excluded because of insufficient follow-up (less than six months) or data loss. We extracted the following risk factors for FRI: gender, body mass index, smoking history, diabetes mellitus, chronic hepatitis, rheumatoid arthritis, dialysis, history of osteoporosis treatment, injury mechanism (high- or low-energy), Vancouver type, and operative information (waiting period for surgery, operation time, amount of blood loss, and surgical procedure). We conducted a logistic regression analysis to investigate the risk factors for FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. Fracture-related infection occurred after surgery for PPF in 12 of 163 patients (7.3%). The most common causative organism was (n = 7). The univariable analysis showed differences for dialysis (p = 0.001), Vancouver type (p = 0.036), blood loss during surgery (p = 0.001), and operative time (p = 0.001). The multivariable logistic-regression analysis revealed that the patient background factor of dialysis (odds ratio [OR], 22.9; p = 0.0005), and the operative factor of Vancouver type A fracture (OR, 0.039-1.18; p = 0.018-0.19) were risk factors for FRI. The rate of post-operative wound infection in patients with a PPF was 7.3%. was the most frequent causative organism. The surgeon should pay attention to infection after surgery for patients with Vancouver type A fractures and those undergoing dialysis.
与股骨假体周围骨折（PPF）治疗相关的骨折感染（FRI）有时会发生。骨折感染常导致多次手术、可能的骨不连、临床功能下降和长期抗生素治疗。在这项多中心研究中，我们旨在阐明 FRI 的发生率、伤口感染的病原体以及与 PPF 术后感染相关的危险因素。在 2010 年至 2019 年期间，11 家机构（称为 TRON 组）对 197 例诊断为股骨假体周围骨折的患者进行了手术治疗，其中 163 例患者被纳入研究对象。34 例患者因随访时间不足（<6 个月）或数据丢失而被排除。我们提取了与 FRI 相关的以下危险因素：性别、体重指数、吸烟史、糖尿病、慢性肝炎、类风湿关节炎、透析、骨质疏松治疗史、损伤机制（高能量或低能量）、温哥华分型和手术信息（手术等待时间、手术时间、失血量和手术过程）。我们进行了逻辑回归分析，使用这些提取的项目作为解释变量，以 FRI 的存在或不存在作为反应变量，来调查 FRI 的危险因素。163 例 PPF 患者中有 12 例（7.3%）在手术后发生了与骨折相关的感染。最常见的病原体是 （n=7）。单变量分析显示，透析（p=0.001）、温哥华分型（p=0.036）、手术期间失血量（p=0.001）和手术时间（p=0.001）存在差异。多变量逻辑回归分析显示，透析患者的背景因素（比值比[OR]，22.9；p=0.0005）和温哥华 A 型骨折的手术因素（OR，0.039-1.18；p=0.018-0.19）是 FRI 的危险因素。PPF 患者术后伤口感染的发生率为 7.3%。是最常见的病原体。外科医生应注意对温哥华 A 型骨折和透析患者术后感染的关注。
