NYU Langone Orthopedic Hospital, Department of Orthopedics, New York, NY, USA; Jamaica Hospital Medical Center, Queens, NY, USA.
NYU Langone Orthopedic Hospital, Department of Orthopedics, New York, NY, USA.
J Orthop Sci. 2024 Sep;29(5):1270-1273. doi: 10.1016/j.jos.2023.08.018. Epub 2023 Oct 13.
Infected fracture nonunions often require prolonged treatment and recovery courses. It is unclear whether the bacterial microbiome influences the time to healing as well as the eradication of infection. The goals of this study are (1) to assess the bacterial microbiome affecting infected nonunions and (2) to evaluate the effects of bacterial speciation on associated outcomes.
Between 2006 and 2022, data from 551 adult patients from a single academic institution who presented with a fracture nonunion were analyzed retrospectively for infection. All patients underwent revision surgery with three sets of cultures obtained intra-operatively. Patients with significant intra-operative cultures were grouped into gram-positive and gram-negative culture cohorts. These patients were managed with a standardized protocol involving surgical debridement, nonunion site fixation, and culture-directed antibiotic treatment. Primary outcome was time to fracture union. Secondary outcomes included number of re-operations and eventual amputation or reconstructive surgery.
56 nonunion patients (10 %) were diagnosed with an infected nonunion (44 g-positive, 12 g-negative). Of these, 3 g-positive patients received an amputation or arthroplasty procedure prior to fracture union, and seven were lost to follow-up. There were no significant differences in age, gender, or nonunion site between cohorts. Most nonunions occurred in the lower extremity. The most common bacteria were staph species (54.3 %). 36 g-positive and 10 g-negative patients achieved fracture union. Time to union was on average 158.4 days longer in the gram-negative cohort-but did not reach statistical significance (446.8 days gram-positive, 662.3 days gram-negative, p = 0.69). There was no difference in re-operation rates (1.9 % gram-positive, 2.2 % gram-negative, p = 0.84).
Patients with infected nonunions had wide-ranging bacterial contamination that were treated successfully using a standardized protocol. However, patients with any gram-negative culture trended toward a delay in time to union.
感染性骨折不愈合通常需要长期的治疗和康复过程。目前尚不清楚细菌微生物组是否会影响愈合时间和感染的消除。本研究的目的是：（1）评估影响感染性不愈合的细菌微生物组；（2）评估细菌分类对相关结果的影响。
在 2006 年至 2022 年期间，对来自一家学术机构的 551 名成人骨折不愈合患者的数据进行了回顾性分析，以评估感染情况。所有患者均接受了翻修手术，术中采集了三组培养物。根据术中培养物的情况，将患者分为革兰氏阳性和革兰氏阴性培养组。这些患者采用标准化方案进行治疗，包括手术清创、不愈合部位固定和针对培养物的抗生素治疗。主要结局是骨折愈合时间。次要结局包括再手术次数和最终截肢或重建手术。
56 名（10%）非愈合患者被诊断为感染性不愈合（44 例革兰氏阳性，12 例革兰氏阴性）。其中，3 例革兰氏阳性患者在骨折愈合前接受了截肢或关节置换术，7 例患者失访。两组患者的年龄、性别或不愈合部位无显著差异。大多数不愈合发生在下肢。最常见的细菌是葡萄球菌（54.3%）。36 例革兰氏阳性和 10 例革兰氏阴性患者实现了骨折愈合。革兰氏阴性组的愈合时间平均延长了 158.4 天，但未达到统计学意义（革兰氏阳性组为 446.8 天，革兰氏阴性组为 662.3 天，p=0.69）。再手术率无差异（革兰氏阳性组 1.9%，革兰氏阴性组 2.2%，p=0.84）。
感染性不愈合患者的细菌污染范围广泛，但采用标准化方案治疗均取得了成功。然而，任何革兰氏阴性培养的患者在愈合时间上都有延迟的趋势。
