Fracture-related infection in long bone fractures: A comprehensive analysis of the economic impact and influence on quality of life

Iliaens, Jorien; Onsea, Jolien; Hoekstra, Harm; Nijs, Stefaan; Peetermans, Willy; Metsemakers, Willem‐Jan

doi:10.1016/j.injury.2021.08.023

Cited by 53 publications

(47 citation statements)

References 28 publications

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“…To investigate the diagnostic performance (i.e., sensitivity and specificity) of sets of suggestive criteria in the entire study population, in the subgroup of patients who did not present with clinical confirmatory criteria or in the subgroup of patients who presented with phenotypically indistinguishable pathogens isolated from at least two separate deep tissue specimens (microbiological confirmatory criterion), suggestive diagnostic criteria were selected based on the following conditions: [1] the test had to be available for the majority of patients ( > 50%) in both the FRI and control group; [2] the test should be associated with a high specificity (defined as ≥80%) and a significant discriminatory value (AUROC > 50%, p < 0.05).…”

Section: Selection Of Suggestive Diagnostic Criteria For Secondary An...mentioning

confidence: 99%

“…Furthermore, the 18 1 The criterion was scored as 'present' if any one of the mentioned signs was present, while it was scored as 'absent' if none of the mentioned signs were present. 2 The percentage and diagnostic performance of a single positive culture was calculated relative to the patients who had no confirmatory microbiological signs (i.e., either single positive cultures or negative culture results). Any clinical sign (redness/swelling/warmth or fever or wound drainage) and if not present, a single positive culture 1 , 2 7 (100.0)…”

Section: Radiological and Nuclear Imaging Signsmentioning

confidence: 99%

“…1 The criterion was scored as 'present' if any of the mentioned signs was present, while it was scored as 'absent' if none of the mentioned signs were present. 2 Because WBC count was not performed in all patients, the percentage and diagnostic performance was calculated relative to the patients for whom WBC count was available. 3 A single positive culture was only included in this study when a virulent pathogen was isolated.…”

Section: • Confirmatory Criteriamentioning

confidence: 99%

“…The criterion was scored as 'present' if any one of the mentioned signs was present, while it was scored as 'absent' if none of the mentioned signs were present 2. Single positive culture caused by virulent pathogens.…”

mentioning

confidence: 99%

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Validation of the diagnostic criteria of the consensus definition of fracture-related infection

Onsea

Lieshout

Zalavras

et al. 2022

Injury

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Section: Selection Of Suggestive Diagnostic Criteria For Secondary An...mentioning

confidence: 99%

Section: Radiological and Nuclear Imaging Signsmentioning

confidence: 99%

Section: • Confirmatory Criteriamentioning

confidence: 99%

mentioning

confidence: 99%

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Validation of the diagnostic criteria of the consensus definition of fracture-related infection

Onsea

Lieshout

Zalavras

et al. 2022

Injury

Self Cite

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“…Good outcomes in fracture care can be adversely affected by fracture-related infection (FRI), leading to non-union and, occasionally, limb loss [ 1 ]. This presents a major burden for patients and healthcare systems around the world [ 2 , 3 ]. Direct hospital costs of FRIs are two to eight times higher than the costs for similar non-infected fractures, with a prolonged loss of employment and a requirement for welfare support [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

What Factors Affect Outcome in the Treatment of Fracture-Related Infection?

et al. 2022

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This international, multi-center study investigated the effect of individual components of surgery on the clinical outcomes of patients treated for fracture-related infection (FRI). All patients with surgically treated FRIs, confirmed by the FRI consensus definition, were included. Data were collected on demographics, time from injury to FRI surgery, soft tissue reconstruction, stabilization and systemic and local anti-microbial therapy. Patients were followed up for a minimum of one year. In total, 433 patients were treated with a mean age of 49.7 years (17–84). The mean follow-up time was 26 months (range 12–72). The eradication of infection was successful in 86.4% of all cases and 86.0% of unhealed infected fractures were healed at the final review. In total, 3.3% required amputation. The outcome was not dependent on age, BMI, the presence of metalwork or time from injury (recurrence rate 16.5% in FRI treated at 1–10 weeks after injury; 13.1% at 11–52 weeks; 12.1% at >52 weeks: p = 0.52). The debridement and retention of a stable implant (DAIR) had a failure rate of 21.4%; implant exchange to a new internal fixation had a failure rate of 12.5%; and conversion to external fixation had a failure rate of 10.3% (adjusted hazard ratio (aHR) DAIR vs. Ext Fix 2.377; 95% C.I. 0.96–5.731). Tibial FRI treated with a free flap was successful in 92.1% of cases and in 80.4% of cases without a free flap (HR 0.38; 95% C.I. 0.14–1.0), while the use of NPWT was associated with higher recurrence rates (HR 3.473; 95% C.I. 1.852–6.512). The implantation of local antibiotics reduced the recurrence from 18.7% to 10.0% (HR 0.48; 95% C.I. 0.29–0.81). The successful treatment of FRI was multi-factorial. These data suggested that treatment decisions should not be based on time from injury alone, as other factors also affected the outcome. Further work to determine the best indications for DAIR, free flap reconstruction and local antibiotics is warranted.

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Mineralized Biopolymers‐Based Scaffold Encapsulating with Dual Drugs for Alveolar Ridge Preservation

Tran,

Luu,

Nguyen

et al. 2024

Macromolecular Bioscience

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Mineralization of scaffolds is essential for alveolar ridge preservation and bone tissue engineering, enhancing the mechanical strength and bioactivity of scaffolds, and promoting better integration with natural bone tissue. While the in situ mineralization method using concentrated SBF solutions is promising, there is limited comprehensive research on its effects. In this study, it is demonstrate that soaking gelatin/alginate scaffolds (GAS) in fivefold concentrated SBF significantly reduces the mineralization time to 3–7 days but also leads to considerable degradation and loss of the scaffold's original microstructure. The ratio of gelatin to alginate is optimized to improve the properties of GAS. The optimized GAS sample, when soaked in concentrated SBF to form GAS/HAp, exhibited hydroxyapatite (HAp) crystal formation starting from day 3, with mature hexagonal crystals forming by day 7. However, this process also caused significant decomposition and deformation of the scaffold's pore structure. Additionally, the biocompatibility of GAS and GAS/HAp is evaluated through in vitro, in ovo, haemolysis, and anti‐ROS assays. The findings highlight the impact of SBF5× on the mineralization of GAS, laying the groundwork for further research in alveolar ridge preservation and bone tissue engineering.

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Fracture-related infection in long bone fractures: A comprehensive analysis of the economic impact and influence on quality of life

Cited by 53 publications

References 28 publications

Validation of the diagnostic criteria of the consensus definition of fracture-related infection

Validation of the diagnostic criteria of the consensus definition of fracture-related infection

What Factors Affect Outcome in the Treatment of Fracture-Related Infection?

Mineralized Biopolymers‐Based Scaffold Encapsulating with Dual Drugs for Alveolar Ridge Preservation

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