Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France.
Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France.
Orthop Traumatol Surg Res. 2024 Oct;110(6):103942. doi: 10.1016/j.otsr.2024.103942. Epub 2024 Jul 19.
Management of infection on internal fixation hardware is particularly complex. The main aim of the present study was to assess bone consolidation rates under septic conditions in patients treated for bone and joint infection (BJI) with hardware retention. Secondary objectives were to determine a time limit beyond which it is unreasonable to retain hardware, and to assess risk factors for non-consolidation and functional results. The study hypothesis was that bone consolidation is possible under septic conditions without hardware exchange.
A single-center retrospective observational study was conducted on 69 patients for the period January 1, 2009 to December 31, 2019. We included all patients aged over 15 years with infection after internal fixation or fusion whose files had been discussed in the multidisciplinary team meeting during the study period. Bone healing was screened for on X-ray or CT. Study data comprised type of fracture, smoking status, time to treatment for open fracture, initial surgery time, type of hardware, interval between fixation and revision, and type of irrigation. Functional results were assessed at follow-up: walking, pain, return to work and SF12 and QuickDASH scores.
The bone healing rate was 73.5% (50/68 patients) at a mean 24 weeks (range, 6-68 weeks). Time to revision did not significantly impact consolidation: 60% for 2 weeks (6/10 cases), 80% for 2-10 weeks (35/40 cases), and 64% for >10 weeks (9/14 cases) (p = 0.28). Smoking, longer initial surgery time and Gustilo type IIIb or IIIc were significant risks factors for non-consolidation.
Bone consolidation under septic conditions with hardware retention adhering to an established medical and surgical protocol was reliable and straightforward, without extra morbidity. These findings are encouraging, and in line with the literature. We were unable to determine a time limit beyond which hardware prevented healing.
IV; descriptive epidemiological study.
内置固定装置感染的处理特别复杂。本研究的主要目的是评估在保留内固定装置的情况下，患有骨和关节感染（BJI）的患者在感染条件下的骨愈合率。次要目标是确定保留内固定装置不合理的时间限制，并评估非愈合和功能结果的危险因素。研究假设是在感染条件下，不更换内固定装置也可以实现骨愈合。
对 2009 年 1 月 1 日至 2019 年 12 月 31 日期间的 69 例患者进行了单中心回顾性观察研究。我们纳入了所有年龄大于 15 岁的、因内置固定或融合术后感染的患者，且在研究期间其病历均在多学科团队会议上进行了讨论。通过 X 射线或 CT 筛查骨愈合情况。研究数据包括骨折类型、吸烟状况、开放性骨折的治疗时间、初次手术时间、内固定物类型、固定与翻修之间的时间间隔以及灌洗类型。通过随访评估功能结果：行走、疼痛、恢复工作情况以及 SF12 和 QuickDASH 评分。
68 例患者中有 73.5%（50/68 例）在平均 24 周（6-68 周）时愈合。翻修时间对愈合无显著影响：2 周时 60%（10/10 例）、2-10 周时 80%（40/50 例）、>10 周时 64%（14/22 例）（p=0.28）。吸烟、初次手术时间较长和 Gustilo Ⅲb 或Ⅲc 型是影响非愈合的显著危险因素。
在遵守既定的医疗和外科方案的情况下，保留内置固定装置，在感染条件下进行骨愈合是可靠且直接的，不会增加额外的发病率。这些发现令人鼓舞，与文献一致。我们无法确定保留内固定装置不合理的时间限制。
IV；描述性流行病学研究。
