Influence of Reaming versus Nonreaming in Intramedullary Nailing on Local Infection Rate

Melcher, Gian A.; Metzdorf, Alexander; Schlegel, U.; Ziegler, Walter J.; Perren, Stephan M.; Printzen, Gert

doi:10.1097/00005373-199512000-00020

Cited by 53 publications

(22 citation statements)

References 19 publications

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“…In one study, common infecting bacteria were staphylococcus aureus; while in another study, the most common isolated bacteria was Escherichia coli, and coagulasenegative staphylococci in the other. The results of this study is consistent with the fascia and Moretti that isolated Gramnegative and coagulase negative Staphylococcus from open fractures of the lower limb in their studies [11][12][13].…”

Section: Resultssupporting

confidence: 91%

Microbial Isolates in Early Swabs of Patients With Lower Limb Open Fractures

Omrani

Darestan

Emami-Moghadam-Tehrani

et al. 2012

nova-jmbs

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Fracture of lower limb is one of the most common orthopedic problems in emergency department. These fractures and particularly the open fractures have complications that among them, infection is most important and dangerous because lead to defect in functional outcomes of limb. Based on above mentioned; in this study we isolate and identified types of microbial that cause infection in lower limb's open fractures. In this cross sectional study, 32 patients with open lower limb fractures were enrolled. Open fracture's specimens were collected by swab and sent to the laboratory for microbial culture immediately. Then patients were compared based on type of isolated microbial contaminant and results of antibiogram. The most frequent was Klebsiella (15.5%), Gram negative bacteria (15.5%), negative coagulase Staphylococcus (12.5%), Staphylococcus Aurous (6.5%). Keywords: Fracture, Infection, Culture, BacteriaIntroduction Given the importance of infection in open fractures, prevention and treatment is of outmost important. There are many different factors that involved in the infection of open fractures, the most known factors are: Lack of prophylactic antibiotics, wound growth's resistance to antibiotics, the prolonged duration between injuries and antibiotic therapy, the extent of tissue damage. In general, it can be assumed that the most common and most important early complication of open fracture wounds is infection; thus necessary measures to deal properly with these type of injuries should be considered promptly [1][2][3][4]. Therefore, in the current study we decided to isolate and identifying common contaminating organisms in the open fracture's wounds through out of specimen's culture, in order to selecting the most effective antibiotics for prevention and treatment of these infections. Method; This was a cross sectional qualitative study conducted at Shahid Rajai hospital in the Tonkabon, between 86 to 87 periods. Patients with open fractures of the lower extremities whom visited the emergency department were included in the study. Bacterial cultures specimens were sent to laboratory. The patient's demographic Information were collected through checklist including age, sex, and microbial culture results. Patients compared based on the contaminated isolates and antibiogram results. Data were analyzed using SPSS software twentieth edition. P <0.05 was considered statistically significant [5][6][7].

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Section: Resultssupporting

confidence: 91%

Microbial Isolates in Early Swabs of Patients With Lower Limb Open Fractures

Omrani

Darestan

Emami-Moghadam-Tehrani

et al. 2012

nova-jmbs

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“…As described in previous publications this technique allows the determination of the level of bacterial concentrations at which differences in the infection rates of the compared groups are most evident [1,2,4,5,14,22,23]. This concentration is close to the level of the infection dose of 50%1 (ID50) [30].…”

Section: Experimental Procedures and Statisticsmentioning

confidence: 87%

Influence of a standardized closed soft tissue trauma on resistance to local infection. An experimental study in rats

Kälicke

Schlegel

Printzen

et al. 2003

Journal Orthopaedic Research

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Purpose: The etiology of local posttraumatic infection in the locomotor system depends on the amount, virulence and pathogenicity of the inoculated microorganisms and the locallsystemic host damage due to the type and extent of the accident or iatrogenic trauma. The relative effect of these factors remains unclear. In particular, it is still unclear today whether-in presence of microorganisms-soft tissue damage and its pathophysiological consequences lead to infection after soft tissue trauma, or whether the bacterial contamination is the primarily cause for posttraumatic infection. The aim of the project was to gain information on the consequences of a soft tissue injury in terms of resistance to local infection. Since clinical populations are too heterogeneous, the problem was investigated in a standardized, reduced (no surgery or implants) experimental in vivo model.Met/zod In female Sprague-Dawley-rats with a standardized closed soft tissue trauma to the tibialis anterior muscle (group 1: n = 13) or without (group 11: n = 13), we compared the incidence of local infection after a pairwise local, percutaneously injected bacterial challenge with various concentrations of Staphylococcus aureus (2 x 104-2 x lo6 colony forming units, CFU). The standardized closed soft tissue trauma was created by application of a specially designed, computer controlled impact device. The contaminated soft tissue and the underlying bone were removed under sterile conditions after five days and quantitatively evaluated for bacterial growths. Infection was defined as positive bacterial growth at the soft tissue and/or bone. A stepwise experimental design with an "up-and-down" dosage technique was used to adjust the bacterial challenge in the area of the ID50 (50% infection dose). Statistical evaluation of the difference between the infection rates of both groups was performed by two-sided fisher exact test (p < 0.05). Results:The overall infection rate was 46%. For the group with soft tissue trauma the ID50 was 1.32 x lo5 CFU and 1.05 x lo6 CFU for the group without soft tissue trauma. The infection rate was 69% (9 of 13 animals) for the group with soft tissue trauma and 23%) (3 of 13 animals) for the group without soft tissue trauma. This difference is statistically significant 0, = 0.047).Conclusions: The infection rate after a standardized closed soft tissue injury was significantly higher and the ID50 lower than without soft tissue trauma. Our results demonstrate that in presence of microorganisms it is not primarily the bacterial contamination but rather the soft tissue damage and its pathophysiological consequences resulting in decreased infection resistance that secondarily lead to infection.

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“…There was a low rate of infection in this series. This may partially be due to the fact that the technique is associated with minimal damage to the blood supply of cortical bone locally [8,11]. Other authors have reported an incidence of infection varying from 2-4% to 11.6% [2,15].…”

Section: Discussionmentioning

confidence: 99%

Primary unreamed intramedullary nailing for open fractures of the tibia

Park

Ihn

et al. 2001

International Orthopaedics

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Forty-six open tibial fractures (42 patients) were treated by primary unreamed intramedullary nailing, with debridement of open wounds and treatment of soft tissue. According to Gustilo-Anderson classification there were 18 grade I cases, 18 grade II cases and 10 grade III cases. The incidence of infection was low with two cases of superficial infection and one of deep infection. The mean time for union was 21.9 weeks and the rate of nonunion was 10.8%. There was no significant difference in the mean time to union, infection rate and rate of nonunion with different site and grade of fracture, but there was a longer union time and a higher rate of nonunion in complex and comminuted fractures. Unreamed intramedullary nailing, with appropriate soft tissue treatment, gives good results in the treatment of open tibial fractures including grade III.Résumé Quarante-six fractures ouvertes du tibia (18 grades I, 18 grades II et 10 grades III d'après GustiloAnderson) ont été traitées avec enclouage centro médul-laire non verrouillé après parage de la plaie et traitement des parties molles. Il y avait deux cas d'infection superficielle et un cas d'infection profonde après un minimum d'observation de 12 mois. Le temps de consolidation moyen était 21.9 semaines, et cinq fractures n'ont pas consolidé. Un délai plus long de consolidation et un taux supérieur de pseudarthrose a été observé dans les fractures complexes et comminutives. Avec un traitement adapté des parties molles, l'enclouage centro medullaire non verrouillé peut être un traitement satisfaisant des fractures ouvertes du tibia, même pour celles de grade III.

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Influence of Reaming versus Nonreaming in Intramedullary Nailing on Local Infection Rate

Cited by 53 publications

References 19 publications

Microbial Isolates in Early Swabs of Patients With Lower Limb Open Fractures

Microbial Isolates in Early Swabs of Patients With Lower Limb Open Fractures

Influence of a standardized closed soft tissue trauma on resistance to local infection. An experimental study in rats

Primary unreamed intramedullary nailing for open fractures of the tibia

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