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3. Could we predict infection after intramedullary nailing of tibial shaft fracture?

Author

Manon, Julie, Detrembleur, Christine, Putineanu, Dan Constantin, Tribak, Karim, Van de Veyver, Simon, Cornu, Olivier, 38th Annual Meeting of the European Bone and Joint Infection Society (EBJIS), UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, and UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur

Subjects
education, human activities, health care economics and organizations
Abstract

Category: Fracture-related Infection - Poster 23

Published
2019

4. Predictors of mechanical complications after intramedullary nailing of tibial fractures.

Author

UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, UCL - (SLuc) Service des urgences, Manon, Julie, Detrembleur, Christine, Van de Veyver, Simon, Tribak, Karim, Cornu, Olivier, Putineanu, Dan Constantin, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, UCL - (SLuc) Service des urgences, Manon, Julie, Detrembleur, Christine, Van de Veyver, Simon, Tribak, Karim, Cornu, Olivier, and Putineanu, Dan Constantin

Abstract

INTRODUCTION: Intramedullary (IM) nailing is the gold standard treatment for tibial shaft fractures, but can be associated with various mechanical complications, including delayed union. HYPOTHESIS: We believe that complications do not occur randomly, but in certain conditions that contribute to their development. Risk factors likely to predict delayed union can be identified to support prevention. MATERIALS AND METHODS: A cohort of 171 fractures treated by IM nailing between 2005 and 2015 was reviewed retrospectively. Independent variables included intrinsic, patient-related factors and extrinsic factors such as those related to the fracture or surgery. A multiple logistic regression model was used to determine which factors can predict each type of complication. RESULTS: Delayed union occurred in 22.8% of patients. Smoking and high-energy trauma were risk factors. Hardware breakage was significantly reduced (p<0.05) when the nail diameter was greater than 10mm. A nail diameter/reamer diameter ratio outside the recommended limits (0.80-0.99) was more likely to be associated with screw failure. Diabetes is a risk factor for hardware migration, which itself is associated with other complications. DISCUSSION: Nonunion is the most common complication after IM nailing of tibial shaft fractures. Smoking cessation after a fracture is necessary in our opinion, even if the literature is ambivalent on this aspect and stopping to smoke once the fracture occurs may not be sufficient to prevent a poor outcome. Use of a nail diameter/reamer diameter between 0.80 and 0.99 favors union and prevents hardware breakage. Hardware migration in a diabetic patient may be a warning sign of other types of complications. LEVEL OF EVIDENCE: Retrospective cohort study. Level IV.

Published
2019

5. Could we predict infection after intramedullary nailing of tibial shaft fracture?

Author

UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, Manon, Julie, Detrembleur, Christine, Putineanu, Dan Constantin, Tribak, Karim, Van de Veyver, Simon, Cornu, Olivier, 38th Annual Meeting of the European Bone and Joint Infection Society (EBJIS), UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, Manon, Julie, Detrembleur, Christine, Putineanu, Dan Constantin, Tribak, Karim, Van de Veyver, Simon, Cornu, Olivier, and 38th Annual Meeting of the European Bone and Joint Infection Society (EBJIS)

Abstract

Category: Fracture-related Infection - Poster 23

Published
2019

6. Can infection be predicted after intramedullary nailing of tibial shaft fractures?

Author

Manon J, Detrembleur C, Van De Veyver S, Tribak K, Cornu O, and Putineanu D

Subjects
Comorbidity, Female, Fractures, Open epidemiology, Fractures, Open surgery, Humans, Male, Middle Aged, Prognosis, Risk Adjustment, Risk Factors, Sensitivity and Specificity, Trauma Severity Indices, Antibiotic Prophylaxis methods, Antibiotic Prophylaxis standards, Emergency Medical Services methods, Emergency Medical Services standards, Fracture Fixation, Intramedullary adverse effects, Fracture Fixation, Intramedullary methods, Surgical Wound Infection diagnosis, Surgical Wound Infection epidemiology, Surgical Wound Infection microbiology, Tibial Fractures diagnosis, Tibial Fractures epidemiology, Tibial Fractures surgery, Time-to-Treatment standards
Abstract

Despite the progress in tibial fracture care, some patients contract infection following intramedullary nailing. We analyzed which risk factors could predict infection in 171 tibial fractures. The independent variables included age, gender, body mass index, and comorbidities, along with external factors of fracture pattern, nailing settings, and treatment processing time. A multiple logistic regression was used to identify infection risk factors. The risk of infection significantly increased according to the open grading, the fractures' classification, time until antibiotic administration, and time until nailing. Gustilo type I fractures presented a higher rate of infection than expected, explained by a longer delay before surgery. The probabilistic equation allows infection prediction with high sensitivity and specificity. In total, we showed that no antibiotics' prescription in emergency service and a transverse fracture pattern were predictors of infection. An infection risk score can be computed, aiding surgeons in decision making. Outcomes could improve keeping these observations in mind. Level of evidence: Retrospective cohort study. Level iii.

Published
2020

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