Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
J Orthop Trauma. 2024 Sep 1;38(9):504-509. doi: 10.1097/BOT.0000000000002853.
To analyze demographics, comorbidities, fracture characteristics, presenting characteristics, microbiology, and treatment course of patients with fracture-related infections (FRIs) to determine risk factors leading to amputation.
Retrospective cohort.
Single Level I Trauma Center (2013-2020).
Adults with lower extremity (femur and tibia) FRIs were identified through a review of an institutional database. Inclusion criteria were operatively managed fracture of the femur or tibia with an FRI and adequate documentation present in the electronic medical record. This included patients whose primary injury was managed at this institution and who were referred to this institution after the onset of FRI as long as all characteristics and risk factors assessed in the analysis were documented. Exclusion criteria were infected chronic osteomyelitis from a non-fracture-related pathology and a follow-up of less than 6 months.
Risk factors (demographics, comorbidities, and surgical, injury, and perioperative characteristics) leading to amputation in patients with FRIs were evaluated.
A total of 196 patients were included in this study. The average age of the study group was 44±16 years. Most patients were men (63%) and White (71%). The overall amputation rate was 9.2%. There were significantly higher rates of chronic kidney disease (CKD; P = 0.039), open fractures (P = 0.034), transfusion required during open reduction internal fixation (P = 0.033), Gram-negative infections (P = 0.048), and FRI-related operations (P = 0.001) in the amputation cohort. On multivariate, patients with CKD were 28.8 times more likely to undergo amputation (aOR = 28.8 [2.27 to 366, P = 0.010). A subanalysis of 79 patients with either a methicillin-sensitive Staphylococcus aureus or methicillin-resistant S. aureus (MRSA) infection showed that patients with MRSA were significantly more likely to undergo amputation compared with patients with methicillin-sensitive Staphylococcus aureus (P = 0.031). MRSA was present in all cases of amputation in the Staphylococcal subanalysis.
Findings from this study highlight CKD as a risk factor of amputation in the tibia and femur with fracture-related infection. In addition, MRSA was present in all cases of Staphylococcal amputation. Identifying patients and infection patterns that carry a higher risk of amputation can assist surgeons in minimizing the burden on these individuals.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
分析与骨折相关感染（FRI）患者的人口统计学、合并症、骨折特征、表现特征、微生物学和治疗过程，以确定导致截肢的危险因素。
回顾性队列研究。
单一级创伤中心（2013-2020 年）。
通过对机构数据库的审查，确定下肢（股骨和胫骨）FRI 患者。纳入标准为股骨或胫骨骨折经手术治疗，且电子病历中有充分记录。这包括在该机构接受主要损伤治疗并在 FRI 发生后转诊至该机构的患者，只要分析中评估的所有特征和危险因素都有记录。排除标准为非骨折相关病理引起的感染性慢性骨髓炎和随访时间少于 6 个月。
评估 FRI 患者截肢的危险因素（人口统计学、合并症和手术、损伤及围手术期特征）。
本研究共纳入 196 例患者。研究组的平均年龄为 44±16 岁。大多数患者为男性（63%）和白人（71%）。总体截肢率为 9.2%。在截肢组中，慢性肾脏病（CKD；P = 0.039）、开放性骨折（P = 0.034）、切开复位内固定时需要输血（P = 0.033）、革兰氏阴性感染（P = 0.048）和 FRI 相关手术（P = 0.001）的发生率明显更高。多变量分析显示，CKD 患者截肢的可能性高 28.8 倍（优势比[OR] = 28.8 [2.27 至 366，P = 0.010]）。对 79 例患有甲氧西林敏感金黄色葡萄球菌或耐甲氧西林金黄色葡萄球菌（MRSA）感染的患者进行的亚分析显示，与甲氧西林敏感金黄色葡萄球菌感染患者相比，MRSA 患者截肢的可能性明显更高（P = 0.031）。在金黄色葡萄球菌亚分析中，所有截肢病例均存在 MRSA。
本研究结果强调 CKD 是胫骨和股骨骨折相关感染截肢的危险因素。此外，MRSA 存在于所有金黄色葡萄球菌截肢病例中。确定具有更高截肢风险的患者和感染模式有助于外科医生最大限度地减少这些患者的负担。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
