Haile Alazar Menbere, Dagnaw Binyam, Gebeyehu Mengistu, Mengesha Solomon, Yoseph Tinsae, Nigussie Hannan, Woldemariam Tobistiya, Wamisho Biruk L, Zeki Kalid
Department of Orthopaedics, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Ethiopia.
Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Ethiopia.
JB JS Open Access. 2025 Jun 20;10(2). doi: 10.2106/JBJS.OA.25.00043. eCollection 2025 Apr-Jun.
Fracture-related infections (FRI) are estimated to complicate approximately 1% of closed fractures and 30% of open fractures globally. These statistics, however, can vary significantly by region, with low-income and middle-income countries experiencing a disproportionately high burden. The studies in these regions are often underpowered to evaluate the local prevalence and contributing factors of FRI. The objectives of this study were (1) to assess the prevalence of FRI in open long-bone injuries and (2) investigate the association between FRI and various risk factors identified in previous research.
A 5-year age-matched and sex-matched case-control study was conducted at 2 high-volume trauma centers in a limited-resource country. Independent variables included demographics (age and sex), anatomical region, injury mechanism, Gustilo-Anderson grade (GA 2 or higher), smoking status, history of blood transfusion, and timing of antibiotic administration, debridement, and soft tissue coverage. The primary outcome was the presence of FRI, as defined by Metsemakers et al., which required direct observation of pus during surgery or additional confirmatory criteria. Data analysis was conducted using the R package vcd.
Seven hundred six cases were reviewed, showing a 13.2% prevalence of FRI. The 84 infected cases and 168 matched controls were analyzed. Most patients experienced delays in antibiotics (77.4%) and debridement (76.6%) beyond 3 hours and 24 hours, respectively. Multivariate logistic regression revealed statistical significance only for a delay in antibiotic administration exceeding 12 hours (p = 0.007), presence of polytrauma (p = 0.008), and non-intramedullary nail (IMN) mode of fixation (p < 0.001). Delays in debridement (>24 hours), soft tissue coverage (>7 days), and antibiotic administration (3-12 hours) did not show statistically significant associations with an increased risk of infection.
Our study highlights the critical importance of prompt antibiotic administration, especially for high-energy wounds such as polytrauma, in reducing infection risk.
Level III. See Instructions for Authors for a complete description of levels of evidence.
据估计，骨折相关感染（FRI）使全球约1%的闭合性骨折和30%的开放性骨折出现并发症。然而，这些统计数据在不同地区可能有很大差异，低收入和中等收入国家的负担尤其沉重。这些地区的研究往往缺乏足够的效力来评估FRI的当地患病率和促成因素。本研究的目的是：（1）评估开放性长骨损伤中FRI的患病率；（2）调查FRI与先前研究中确定的各种风险因素之间的关联。
在一个资源有限国家的2个高流量创伤中心进行了一项为期5年的年龄和性别匹配的病例对照研究。自变量包括人口统计学特征（年龄和性别）、解剖区域、损伤机制、 Gustilo-Anderson分级（GA 2级或更高）、吸烟状况、输血史以及抗生素给药、清创和软组织覆盖的时间。主要结局是根据Metsemakers等人的定义确定是否存在FRI，这需要在手术期间直接观察到脓液或有其他确认标准。使用R软件包vcd进行数据分析。
共审查了706例病例，FRI患病率为13.2%。对84例感染病例和168例匹配对照进行了分析。大多数患者的抗生素给药（77.4%）和清创（76.6%）分别延迟超过3小时和24小时。多因素逻辑回归显示，仅抗生素给药延迟超过12小时（p = 0.007）、存在多发伤（p = 0.008）和非髓内钉（IMN）固定方式（p < 0.001）具有统计学意义。清创延迟（>24小时）、软组织覆盖延迟（>7天）和抗生素给药延迟（3 - 12小时）与感染风险增加无统计学显著关联。
我们的研究强调了及时给予抗生素的至关重要性，特别是对于多发伤等高能量伤口，以降低感染风险。
III级。有关证据级别的完整描述，请参阅《作者须知》。
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