Factors affecting rates of infection and nonunion in intramedullary nailing

Malik, M. H. A.; Harwood, Paul; Diggle, Peter J.; Khan, Shoaib

doi:10.1302/0301-620x.86b4.14097

Cited by 153 publications

(62 citation statements)

References 21 publications

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“…As noted by previous authors, it is difficult to treat and has a high financial impact [22,23]. With respect to femoral shaft fractures, IMN is an effective treatment option with nonunion rates less than 10%, regardless of the starting point [1,3], and infection rates in large series ranging from 1% to 3.8% [24]. The advantages of intramedullary fixation include early stable fixation, early mobilization of hip and knee joints, and less soft tissue damage.…”

Section: Discussionmentioning

confidence: 93%

Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: Remaining controversies

Metsemakers

Roels

Belmans

et al. 2015

Injury

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Fracture stabilisation with IMN is a good treatment option for femoral shaft fractures in adults. The purpose of this study was to evaluate risk factors of poor outcome after IMN of femoral shaft fractures. The present analysis revealed that there was no difference in the outcome whether the fracture was reamed or not. Univariate and multivariate analysis could only correlate AO/OTA fracture type with the occurrence of nonunion. Therefore, in this study, unreamed nailing and damage control EF were not associated with a negative outcome.

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Section: Discussionmentioning

confidence: 93%

Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: Remaining controversies

Metsemakers

Roels

Belmans

et al. 2015

Injury

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“…Rates of SSI after surgery for closed fractures range from 1 to 4% [2, 3]. Perioperative antibiotic prophylaxis can help prevent SSI, and studies have shown the benefit of administering antibiotics immediately before skin incision in closed fracture surgery [4–11].…”

Section: Introductionmentioning

confidence: 99%

Current practice of antibiotic prophylaxis for surgical fixation of closed long bone fractures: a survey of 297 members of the Orthopaedic Trauma Association

et al. 2017

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Background: The risk of postoperative surgical site infection after long bone fracture fixation can be decreased with appropriate antibiotic use. However, there is no agreement on the superiority of a single-or multiple-dose perioperative regimen of antibiotic prophylaxis. The purpose of this study is to determine the following: 1) What are the current practice patterns of orthopaedic trauma surgeons in using perioperative antibiotics for closed long bone fractures? 2) What is the current knowledge of published antibiotic prophylaxis guidelines among orthopaedic trauma surgeons? 3) Are orthopaedic surgeons willing to change their current practices? Methods: A questionnaire was distributed via email between September and December 2015 to 955 Orthopaedic Trauma Association members, of whom 297 (31%) responded. Results: Most surgeons (96%) use cefazolin as first-line infection prophylaxis. Fifty-nine percent used a multiple-dose antibiotic regimen, 39% used a single-dose regimen, and 2% varied this decision according to patient factors. Thirty-six percent said they were unfamiliar with Centers for Disease Control and Prevention (CDC) antibiotic prophylaxis guidelines; only 30% were able to select the correct CDC recommendation from a multiple-choice list. However, 44% of surgeons said they followed CDC recommendations. Fifty-six percent answered that a single-dose antibiotic prophylaxis regimen was not inferior to a multiple-dose regimen. If a level-I study comparing a single preoperative dose versus multiple perioperative antibiotic dosing regimen for treatment of closed long bone fractures were published, most respondents (64%) said they would fully follow these guidelines, and 22% said they would partially change their practice to follow these guidelines. Conclusion: There is heterogeneity in the use of single-versus multiple-dose antibiotic prophylaxis for surgical repair of closed long bone fractures. Many surgeons were unsure of current evidence-based recommendations regarding perioperative antibiotic use. Most respondents indicated they would be receptive to high-level evidence regarding the single-versus multiple-dose perioperative prophylactic antibiotics for the treatment of closed long bone fractures.

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“…Otro tipo es el clavo de Ender, ligeramente curvo, que también es biselado en su extremo distal (4,5,27) . Las complicaciones descritas en los clavos intramedulares incluyen separación de los fragmentos, cambios en la longitud del hueso, penetración articular, inmovilización inadecuada, fallas en el sistema de fijación (1,5,(28)(29) (Figura 20).…”

Section: A 16aunclassified

Elementos De Osteosintesis De Uso Habitual en Fracturas Del Esqueleto Apendicular: Evaluacion Radiologica

M¹,

T²

2005

Rev. chil. radiol.

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58tanto, conocerlos, especialmente los usados en nuestros lugares de trabajo, y saber qué parámetros debemos evaluar para un mejor informe radiológico.De las múltiples intervenciones sobre el hueso un común denominador son los elementos de osteosíntesis (OTS), aparatos mecánicos construidos principalmente de acero inoxidable, titanio o elementos biodegradables.Centraremos nuestra revisión en las fracturas del esqueleto apendicular, que es la patología ósea de mayor frecuencia. Ellas pueden ser tratadas con: a) Métodos cerrados, en los que se hace reducción cerrada, estabilización e inmovilización con yeso y menos comúnmente con aparatos de tracción. b) Métodos abiertos, en los que la reducción es quirúrgica o percutánea, y se efectúa estabilización y fijación interna con aparatos de OTS. c) Métodos externos con reducción, estabilización y uso de fijadores externos.Cada vez que es posible, la mayoría de los traumatólogos prefiere tratar con reducción cerrada, recuperación del alineamiento óseo y estabilización con aparatos de tracción o compresión externa, como valvas o yesos. En caso contrario, efectúan la fijación quirúrgica con reducción anatómica de los fragmentos y mantención con algún sistema de fijación, preservando el flujo sanguíneo al hueso y tejidos blandos, utilizando la técnica menos traumática posible para permitir una rápida cicatrización, recuperación precoz de la movilidad y función completa del miembro dañado.La concepción actual, sin embargo, es buscar la reducción más fisiológica posible y no necesariamente un alineamiento perfecto. Elementos utilizados en el tratamiento cerrado u ortopédico.Su objetivo principal es promover la formación de callo externo, estimulándolo con recuperación precoz de la actividad muscular, del movimiento articular y transmisión de carga. La fractura se reduce, estabiliza e inmoviliza mediante maniobras externas al foco, sin alteración del flujo sanguíneo. Abstract: Coping with orthopaedic hardware imaging has always been difficult for radiologists. We don't know adequately fixation devices implemented in fracture fixation, their characteristics, biomechanical principles, potential complications and how to report them properly. The following is a revision of these topics and suggestions in order to improve our skills in reporting as well. ELEMENTOS DE OSTEOSINTESIS DE USO HABITUAL EN FRACTURAS DEL ESQUELETO APENDICULAR

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Factors affecting rates of infection and nonunion in intramedullary nailing

Cited by 153 publications

References 21 publications

Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: Remaining controversies

Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: Remaining controversies

Current practice of antibiotic prophylaxis for surgical fixation of closed long bone fractures: a survey of 297 members of the Orthopaedic Trauma Association

Elementos De Osteosintesis De Uso Habitual en Fracturas Del Esqueleto Apendicular: Evaluacion Radiologica

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