Infection after reamed intramedullary nailing of lower limb fractures: A review of 1,464 cases over 15 years

Jenny, Jean–Yves; Jenny, G; Kempf, I

doi:10.3109/17453679408993727

Cited by 33 publications

(13 citation statements)

References 8 publications

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“…The infection rates in the present study are comparable to published infection rates in high-income countries [24–26], even in the higher end of the range [27]. However, there is a widespread belief among surgeons that the risk of postoperative infection is very high in LMIC.…”

Section: Discussionsupporting

confidence: 81%

Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low‐ and Middle‐income Countries

et al. 2012

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BackgroundThe fields of surgery and trauma care have largely been neglected in the global health discussion. As a result the idea that surgery is not safe or cost effective in resource-limited settings has gone unchallenged. The SIGN Online Surgical Database (SOSD) is now one of the largest databases on trauma surgery in low- and middle-income countries (LMIC). We wished to examine infection rates and risk factors for infection after IM nail operations in LMIC using this data.MethodsThe SOSD contained 46,722 IM nail surgeries in 58 different LMIC; 46,113 IM nail operations were included for analysis.ResultsThe overall follow-up rate was 23.1 %. The overall infection rate was 1.0 %, 0.7 % for humerus, 0.8 % for femur, and 1.5 % for tibia fractures. If only nails with registered follow-up (n = 10,684) were included in analyses, infection rates were 2.9 % for humerus, 3.2 % for femur, and 6.9 % for tibia fractures. Prophylactic antibiotics reduced the risk of infection by 29 %. Operations for non-union had a doubled risk of infection. Risk of infection was reduced with increasing income level of the country.ConclusionsThe overall infection rates were low, and well within acceptable levels, suggesting that it is safe to do IM nailing in low-income countries. The fact that operations for non-union have twice the risk of infection compared to primary fracture surgery further supports the use of IM nailing as the primary treatment for femur fractures in LMIC.

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Section: Discussionsupporting

confidence: 81%

Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low‐ and Middle‐income Countries

et al. 2012

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“…The overall infection rates in the SOSD are comparable to results from the literature in high-income countries (Court-Brown et al 1992, Jenny et al 1994, Wolinsky et al 1999), even in the higher end of the range indicated above (Malik et al 2004). However, most centers in high-income countries are likely to have even lower infection rates.…”

Section: Discussionsupporting

confidence: 81%

Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries

Young¹,

Lie²,

Hallan³

et al. 2011

Acta Orthopaedica

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Background The Surgical Implant Generation Network (SIGN) supplies intramedullary (IM) nails for the treatment of long bone fractures free of charge to hospitals in low- and middle-income countries (LMICs). Most operations are reported to the SIGN Online Surgical Database (SOSD). Follow-up has been reported to be low, however. We wanted to examine the pattern of follow-up and to assess whether infection rates could be trusted.Patients and methods The SOSD contained 36,454 IM nail surgeries in 55 LMICs. We excluded humerus and hip fractures, and fractures without a registered surgical approach. This left 34,361 IM nails for analysis. A generalized additive regression model (gam) was used to explore the association between follow-up rates and infection rates.Results The overall follow-up rate in the SOSD was 18.1% (95% CI: 17.7–18.5) and national follow-up rates ranged from 0% to 74.2%. The overall infection rate was 0.7% (CI: 0.6–0.8) for femoral fractures and 1.2% (CI: 1.0–1.4) for tibial fractures. If only nails with a registered follow-up visit were included (n = 6,224), infection rates were 3.5% (CI: 3.0–4.1) for femoral fractures and 7.3% (CI: 6.2–8.4) for tibial fractures. We found an increase in infection rates with increasing follow-up rates up to a level of 5%. Follow-up above 5% did not result in increased infection rates.Interpretation Reported infection rates after IM nailing in the SOSD appear to be reliable and could be used for further research. The low infection rates suggest that IM nailing is a safe procedure also in low- and middle-income countries.

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“…The longitudinal fixation of the nail is achieved by insertion into the metaphysis, especially in the distal fragment. One disadvantage of the Trilam nail operation is the open surgical approach, which increases the risk of infection (15,22). Short-term antibiotic treatment is therefore recommended.…”

Section: Discussionmentioning

confidence: 99%

Initial experience with a newly developed medullary stabilization nail (Trilam nail)

Hach¹

2000

Vet Comp Orthop Traumatol

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SummaryThe Trilam nail is made of stainless steel and has three lamellae running along its length. After surgical exposure the fragments are speared together with the pointed end of the nail. Eightynine limb fractures we repaired by this means. The type of fracture played a secondary role. Healing was achieved in all of the cases. Due to telescopic instability in one and slight collapse of the fracture surgical recorrection had to be performed in two cases. The advantages of the Trilam nail, over alternative surgical procedures for osteosynthesis, are that it is possible to treat fractures close to the metaphysis and to ensure rotational stability, as well as a reduction in the operating time.This paper reports on the treatment of fractures in small animals with a newly developed, rotationally stable intramedullary nail. It was used in dogs, cats, rabbits, a bird and a monkey for transverse, oblique, spiral and comminuted fractures.

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Infection after reamed intramedullary nailing of lower limb fractures: A review of 1,464 cases over 15 years

Cited by 33 publications

References 8 publications

Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low‐ and Middle‐income Countries

Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low‐ and Middle‐income Countries

Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries

Initial experience with a newly developed medullary stabilization nail (Trilam nail)

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