Behandlungstaktik und Spätergebnisse bei Frühinfekt nach Osteosynthese

Willenegger, H; Roth, Bernard

doi:10.1007/bf02586085

Cited by 83 publications

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“…Maûgebend fu È r die Diagnose eines postoperativen Infekts sind neben klinischen Kriterien wie allgemeine Entzu È ndungszeichen, BSG-und Leukocytenerho È hung auch ein positives bakteriologisches Ergebnis [14]. Dabei beschra È nkten wir uns nie auf einen bloûen ¹Ab-strichª, sondern versuchten stets Gewebe und/oder Sekret einzuschicken.…”

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“…In der bereits erwa È hnten, geplanten multizentrischen Studie werden diese Maûnahmen auf ihre Effizienz hin untersucht werden. Abweichend von unseren Beobachtungen erreichte Willenegger mit der langzeitigen Saug-Spu È l-Drainage unter Belassung der Implantate gute Ergebnisse [14], selbst Infekte von Plattenosteosynthesen konnten im Gegensatz zu unserer Studie ohne Materialentfernung saniert werden. Wir erachten dennoch die langzeitige Saug-Spu È l-Drainage, besonders im Bereich langer Ro È hrenknochen mit freiem Zugang zur Markho È hle, fu È r nicht ausreichend.…”

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“…Im Vergleich zur Literatur hat sich daran nichts gea È ndert [3,13,14]. Erwartungsgema È û zeigt die Verteilung der Risikofaktoren eine deutliche Belastung jener Patienten, bei denen nach postoperativer Fru È hinfektion die Sanierung des Infekts nur durch die Materialentfernung gelang.…”

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Osteosyntheseimplantat und früher postoperativer Infekt: Sanierung mit oder ohne Materialentfernung?

Hofmann

Bär

Bühren

1997

Chirurg

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This prospective study served as a quality control of a revision concept for case of post-traumatic infection following open reduction and internal fixation in fracture treatment. It is based on clinical and microbiological criteria and has two aims: (1) eradication of the infection and avoidance of development of chronic osteitis; (2) maintenance of internal fixation, if possible. Thirty-four patients were recruited in this study. Surgical revisions were performed according to a consistent concept (debridement, irrigation, local chemotherapy, drainage) in defined time intervals (2 days). The operation site had to be bacteriologically clean after four revisions. Otherwise, the implant had to be removed. Both aims were reached in 11 cases: management of infection with maintenance of internal fixation. In 23 cases the implant material had to be removed. Nevertheless the infection was eliminated in all these patients without exception. The following risk factors for mandatory implant removal were evaluated: diabetes, arteriosclerosis, alcoholism, nicotine. This revision concept helps in the management of acute postoperative osteitis following ORIF in fracture treatment and in avoiding the development of chronic osteitis.

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Osteosyntheseimplantat und früher postoperativer Infekt: Sanierung mit oder ohne Materialentfernung?

Hofmann

Bär

Bühren

1997

Chirurg

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“…An early and a consequent management is necessary to prevent the development of chronic osteitis from an acute one [8].…”

Section: Introductionmentioning

confidence: 99%

“…A single case of the chronic osteitis costs nearly 500 000 Euro. In Germany 1000 cases per year are expected [1].An early and a consequent management is necessary to prevent the development of chronic osteitis from an acute one [8]. …”

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Intermittent Debridement and Nail Change - a Successful Strategy for the Treatment of Acute Osteitis of the Femur

Militz¹,

Stein²,

Zobel³

et al. 2002

Osteosynthesis and Trauma Care

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IntroductionThe rate of infection after osteosynthesis of long bones is very small. Today most of the fractures of the femur are stabilised with a nail. But a case of acute osteitis after nailing a fracture of the femur seems to be a disaster for the patient and the surgeon. The pathogenesis of acute osteitis is a result of open fractures, iatrogenic failures of operative management and inconsistent management of postoperative complications [1, 4 ± 7]. In 10± 30 % of cases a chronic osteitis develops out of an acute one. The common rate of osteitis after any osteosynthesis of fractured bone is 0.5±1 %. The treatment costs of the chronic osteitis are much higher than the costs for the consequent therapy of the acute osteitis. A single case of the chronic osteitis costs nearly 500 000 Euro. In Germany 1000 cases per year are expected [1].An early and a consequent management is necessary to prevent the development of chronic osteitis from an acute one [8]. Materials and MethodsThe idea was to obtain a fracture healing with good function and without any residue of infection. To realise this concept an early revision of the wound and the bone marrow for reduction of the amount of bacteria was done. This included the removal of the implant during every session. After cleaning the wound, the instruments, gloves and cover were changed and a resterilised implant for stabilisation of the fractured and unstable bone was used. Results83 patients with an acute osteitis were treated from 1998 to 2000. 4 of them (4.9 %) had osteitis of the femur after the nailing procedure of the fracture. The average number of the salvage procedures done was six. No further bacterial growth was found in the marrow hole after the last salvage procedures. The fractured bone was stabilised temporarily with a resterilised nail. In two cases the implant was a gamma nail, in the other two an interlocking-compression nail.In all cases the 16-months follow-up period showed no further infection and the fractures healed with good function. We were able to prevent the development of chronic osteitis by a consequent surgical management in all cases. Case ReportA 23-years-old male with a II8-open fracture of the right femur was admitted to our hospital with Clostridium perfringens in the wound.Therapy: Resection of the infected bone, temporary spacer with cement and stabilisation of the femur with resterilised nail, salvage procedure done 6 times, with the last revision the defect of the bone was filled up with osteocutaneuos flap. AbstractIn cases of acute osteitis, post-osteosynthesis of a fracture of the femur, a consequent therapy is necessary. The goal is to prevent it from developing into a chronic osteitis. We treated 4 patients with the rare cases of acute osteitis of the femur after nailing a fracture. A salvage procedure was done for the reduction of bacteria in the bone and soft tissue on all patients. The average follow-up time of the reported cases was 16 months. The fractures were healed, the function of the leg was good, and we did not find ...

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Implant‐Associated Osteomyelitis of Long Bones

McNally¹,

Sendi²

2015

Bone and Joint Infections

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Behandlungstaktik und Spätergebnisse bei Frühinfekt nach Osteosynthese

Cited by 83 publications

References 0 publications

Osteosyntheseimplantat und früher postoperativer Infekt: Sanierung mit oder ohne Materialentfernung?

Osteosyntheseimplantat und früher postoperativer Infekt: Sanierung mit oder ohne Materialentfernung?

Intermittent Debridement and Nail Change - a Successful Strategy for the Treatment of Acute Osteitis of the Femur

Implant‐Associated Osteomyelitis of Long Bones

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