No increased risk of acute osteomyelitis associated with closed or open long bone shaft fracture

Abstract

Objectives: Osteomyelitis of the long bones can result from hematogenous spread, direct inoculation or from a contiguous focus of infection. The association of osteomyelitis after long bone fractures has widely been believed to be true by practicing surgeons since the 1950s, even though the evidence has been poor. We hypothesized that long bone shaft fracture and major bone surgery are independent risk factors for osteomyelitis in adult trauma patients. Methods: The National Trauma Data Bank (NTDB) was queried between 2007 and 2015 for patients 18 years of age presenting after trauma. Patients with long bone shaft fractures (femur, tibia/fibula, humerus) were identified and rate of acute osteomyelitis was calculated. Univariable logistic regression was performed. A multivariable logistic regression was performed to identify risk factors for development of acute osteomyelitis. Results: From 5,494,609 patients, 358,406 were identified to have long bone shaft fractures (6.5%) with the majority being tibia/fibula (44.3%). The osteomyelitis rate in long bone shaft fractures was 0.05%. Independent risk factors for osteomyelitis included major humerus surgery and major tibia/fibula surgery. The strongest risk factor was non-pseudomonas bacteremia. Long bone shaft fractures were not found to be an independent risk factor for osteomyelitis (p > 0.05). Conclusions: Long bone shaft fractures are not independently associated with increased risk for osteomyelitis. Major extremity surgery on the humerus and tibia/fibula, but not femur, are independent risk factors for osteomyelitis. However, the strongest risk factor is non-pseudomonas bacteremia.

Risk Factors for Postoperative Osteomyelitis among Patients after Bone Fracture: A Matched Case–Control Study

“…We also found that type of the fracture (open or close) is an independent risk factor for osteomyelitis (OR 6.25 CI 1.64–23.79). This contradicts the results of the study by Grigorian et al [ 22 ]. However, earlier studies showed results similar to ours [ 23 , 24 ].…”

Osteomyelitis with abscess associated with acute closed upper humerus fracture in an adult: A case report

“…6 S. aureus is the most common cause of osteomyelitis in adults. 1,2,24,25 In our case and in some of these prior cases, it is possible that the osteomyelitis was subacute or chronic, resulting in weakening of the bone. In this theoretical context, these fractures would be considered pathological.…”

“…(Case 5 from 7 ), and Escherichia coli 6 . S. aureus is the most common cause of osteomyelitis in adults 1,2,24,25 …”

Osteomielitis aguda: clasificación, fisiopatología y diagnóstico

“…En los adultos es una patología menos frecuente y se encuentra mayormente asociada a factores de riesgo como traumatismos con alta probabilidad de infección (1). En casos traumáticos, se ha informado que la osteomielitis aguda ocurre con mayor frecuencia después de fracturas abiertas de huesos largos con incidencia de 4-63% (11). Por otro lado, las infecciones protésicas articulares representan una entidad relativamente nueva de osteomielitis, su incidencia oscila entre 1,5-2,5%, aunque se han reportado tasas de hasta 20% luego de la revisión quirúrgica (1).…”

“…Un estudio reciente realizado en España reveló que los niños con osteomielitis e554 fueron hospitalizados por un promedio de 13.5 días, que el 20% requirió cirugía y que el 2.3% desarrolló secuelas a largo plazo, como la discrepancia en la longitud de las piernas (12). Se ha descrito un aumento del número de casos de osteomielitis aguda de hasta 2,8 veces en los últimos 20 años lo que podría deberse a la mejora de las técnicas diagnósticas (11). La osteomielitis se considera una enfermedad con una alta tasa de secuelas, en especial en países de bajos recursos económicos, en los cuales los pacientes pueden llegar a desarrollar una enfermedad avanzada, crónica y asociada a complicaciones clínicas importantes y en algunos casos evolucionar hasta la muerte del paciente (1).…”