Alcaide Doriann, Blackwood Nigel, Yeager Matthew, Rutz Robert, Benson Elizabeth, Carter Karen, Gross Evan, Spitler Clay, Johnson Joey
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA.
Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, USA.
Eur J Orthop Surg Traumatol. 2025 Feb 24;35(1):74. doi: 10.1007/s00590-025-04202-x.
To compare the surgical and microbiological characteristics of fracture related infection (FRI) that had union and those requiring additional surgery to promote bone healing. We hypothesized that FRIs with MRSA will have higher risk for reoperation to promote bone healing.
This is a retrospective study on 247 patients over 18 who underwent bone fixation for pelvis, upper, and lower extremities fractures between 2013 and 2021 at a level I trauma center. All cases had an FRI and at least 6 months of follow-up after diagnosis. Patients with pathologic fracture due to underlying malignancy and patients with spinal fractures were excluded. We compared surgical and microbiological characteristics of fractures between cases that required reoperation to promote bone healing and those who did not.
Of 247 patients, 55 (22.2%) required reoperations to promote bone healing after diagnosis of FRI. Patients that received topical antibiotics at closure during initial fixation had higher risk for reoperations to promote bone healing (30.8% vs. 15.2%, p = 0.049). Infection with Pseudomonas aeruginosa was associated with a lower risk for reoperations to promote bone healing (0%, p = 0.040). Rates of patients requiring reoperations to promote bone healing in infections with MRSA were similar to infections with MSSA (19.6% vs 20.9%, p = 1.000) and other pathogens (19.6% vs 23%; p = 0.539). Open fracture (OR 0.785, p = 0.534), tobacco use (OR 0.557, p = 0.126), upper extremity (OR 0.730, p = 0.534) or use of topical antibiotic at closure (OR 0.439, p = 0.067) did not increase risk for reoperation to promote bone healing.
Using topical antibiotics for skin closure during initial fixation for bone fractures may increase the risk of reoperation to promote bone healing, while infection with P. aeruginosa decreases the risk. Infection with MRSA or MSSA did not increase risk for requiring reoperation to promote bone healing after FRI diagnosis. Further studies should examine the impact of topical antibiotics during fracture surgery on development of FRI.
比较已愈合的骨折相关感染（FRI）与需要额外手术促进骨愈合的骨折相关感染的手术和微生物学特征。我们假设耐甲氧西林金黄色葡萄球菌（MRSA）引起的FRI再次手术促进骨愈合的风险更高。
这是一项对247例18岁以上患者的回顾性研究，这些患者于2013年至2021年在一级创伤中心接受了骨盆、上肢和下肢骨折的内固定手术。所有病例均患有FRI，诊断后至少随访6个月。排除因潜在恶性肿瘤导致的病理性骨折患者和脊柱骨折患者。我们比较了需要再次手术促进骨愈合的病例与无需再次手术的病例之间骨折的手术和微生物学特征。
247例患者中，55例（22.2%）在诊断为FRI后需要再次手术促进骨愈合。初次固定闭合时接受局部抗生素治疗的患者再次手术促进骨愈合的风险更高（30.8%对15.2%，p = 0.049）。铜绿假单胞菌感染与再次手术促进骨愈合的风险较低相关（0%，p = 0.040）。MRSA感染患者再次手术促进骨愈合的比例与甲氧西林敏感金黄色葡萄球菌（MSSA）感染患者（19.6%对20.9%，p = 1.000）及其他病原体感染患者（19.6%对23%；p = 0.539）相似。开放性骨折（比值比[OR]0.785，p = 0.534）、吸烟（OR 0.557，p = 0.126）、上肢骨折（OR 0.730，p = 0.534）或闭合时使用局部抗生素（OR 0.439，p = 0.067）并未增加再次手术促进骨愈合的风险。
骨折初次固定闭合时使用局部抗生素可能会增加再次手术促进骨愈合的风险，而铜绿假单胞菌感染则降低了这种风险。FRI诊断后，MRSA或MSSA感染并未增加需要再次手术促进骨愈合的风险。进一步研究应探讨骨折手术期间局部抗生素对FRI发生的影响。
