Risk Factors for Infection After Intramedullary Nailing of Open Tibial Shaft Fractures in Low- and Middle-Income Countries
OBJECTIVES:(1) To determine the infection rate after fixation of open tibial shaft fractures using the Surgical Implant Generation Network (SIGN) intramedullary nail in low- and middle-income countries (LMICs) and (2) to identify risk factors for infection. DESIGN:Prospective cohort study using an i...
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| Veröffentlicht in: | Journal of orthopaedic trauma 2019-06, Vol.33 (6), p.e234-e239 |
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| creator | Whiting, Paul S Galat, Daniel D Zirkle, Lewis G Shaw, Michael K Galat, Jeremiah D |
| description | OBJECTIVES:(1) To determine the infection rate after fixation of open tibial shaft fractures using the Surgical Implant Generation Network (SIGN) intramedullary nail in low- and middle-income countries (LMICs) and (2) to identify risk factors for infection.
DESIGN:Prospective cohort study using an international online database.
SETTING:Multiple hospitals in LMICs worldwide.
PATIENTS/PARTICIPANTS:A total of 1061 open tibia fractures treated with the SIGN nail in LMICs between March 2000 and February 2013.
INTERVENTION:Intravenous antibiotic administration, surgical debridement, and definitive intramedullary nailing within 14 days of injury.
MAIN OUTCOME MEASUREMENTS:Deep or superficial infection at follow-up, implant breakage/loosening, angular deformity >10 degrees, repeat surgery, radiographic union, weight bearing, and ability to kneel.
RESULTS:The overall infection rate was 11.9%. Infection rates by the Gustilo and Anderson classification were type 15.1%, type II12.6%, type IIIa12.5%, type IIIb29.1%, and type IIIc16.7% (P = 0.001 between groups). Patients who developed infection had a longer mean time from injury to definitive surgery (4.7 vs. 3.9 days, P = 0.03) and from injury to wound closure (13.7 vs. 3.6 days, P < 0.001). Distal fractures had a higher infection rate than midshaft fractures (13.3% vs. 8.2%, P = 0.03). Infection rates were not associated with time from injury to initial debridement, time from injury to initial antibiotic administration, or total duration of antibiotics.
CONCLUSIONS:Open tibia fractures can be managed effectively using the SIGN intramedullary nail in LMICs with an overall infection rate of 11.9%. Risk factors for infection identified include more severe soft-tissue injury, delayed nailing, delayed wound closure, and distal fracture location.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| doi_str_mv | 10.1097/BOT.0000000000001441 |
| format | Article |
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DESIGN:Prospective cohort study using an international online database.
SETTING:Multiple hospitals in LMICs worldwide.
PATIENTS/PARTICIPANTS:A total of 1061 open tibia fractures treated with the SIGN nail in LMICs between March 2000 and February 2013.
INTERVENTION:Intravenous antibiotic administration, surgical debridement, and definitive intramedullary nailing within 14 days of injury.
MAIN OUTCOME MEASUREMENTS:Deep or superficial infection at follow-up, implant breakage/loosening, angular deformity >10 degrees, repeat surgery, radiographic union, weight bearing, and ability to kneel.
RESULTS:The overall infection rate was 11.9%. Infection rates by the Gustilo and Anderson classification were type 15.1%, type II12.6%, type IIIa12.5%, type IIIb29.1%, and type IIIc16.7% (P = 0.001 between groups). Patients who developed infection had a longer mean time from injury to definitive surgery (4.7 vs. 3.9 days, P = 0.03) and from injury to wound closure (13.7 vs. 3.6 days, P < 0.001). Distal fractures had a higher infection rate than midshaft fractures (13.3% vs. 8.2%, P = 0.03). Infection rates were not associated with time from injury to initial debridement, time from injury to initial antibiotic administration, or total duration of antibiotics.
CONCLUSIONS:Open tibia fractures can be managed effectively using the SIGN intramedullary nail in LMICs with an overall infection rate of 11.9%. Risk factors for infection identified include more severe soft-tissue injury, delayed nailing, delayed wound closure, and distal fracture location.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0890-5339</identifier><identifier>EISSN: 1531-2291</identifier><identifier>DOI: 10.1097/BOT.0000000000001441</identifier><identifier>PMID: 30702501</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><ispartof>Journal of orthopaedic trauma, 2019-06, Vol.33 (6), p.e234-e239</ispartof><rights>Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2861-e49b5dce98a75a88da59f9612a678bbca893ec75525763fd18dbf2d7a7a340a03</citedby><cites>FETCH-LOGICAL-c2861-e49b5dce98a75a88da59f9612a678bbca893ec75525763fd18dbf2d7a7a340a03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30702501$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Whiting, Paul S</creatorcontrib><creatorcontrib>Galat, Daniel D</creatorcontrib><creatorcontrib>Zirkle, Lewis G</creatorcontrib><creatorcontrib>Shaw, Michael K</creatorcontrib><creatorcontrib>Galat, Jeremiah D</creatorcontrib><title>Risk Factors for Infection After Intramedullary Nailing of Open Tibial Shaft Fractures in Low- and Middle-Income Countries</title><title>Journal of orthopaedic trauma</title><addtitle>J Orthop Trauma</addtitle><description>OBJECTIVES:(1) To determine the infection rate after fixation of open tibial shaft fractures using the Surgical Implant Generation Network (SIGN) intramedullary nail in low- and middle-income countries (LMICs) and (2) to identify risk factors for infection.
DESIGN:Prospective cohort study using an international online database.
SETTING:Multiple hospitals in LMICs worldwide.
PATIENTS/PARTICIPANTS:A total of 1061 open tibia fractures treated with the SIGN nail in LMICs between March 2000 and February 2013.
INTERVENTION:Intravenous antibiotic administration, surgical debridement, and definitive intramedullary nailing within 14 days of injury.
MAIN OUTCOME MEASUREMENTS:Deep or superficial infection at follow-up, implant breakage/loosening, angular deformity >10 degrees, repeat surgery, radiographic union, weight bearing, and ability to kneel.
RESULTS:The overall infection rate was 11.9%. Infection rates by the Gustilo and Anderson classification were type 15.1%, type II12.6%, type IIIa12.5%, type IIIb29.1%, and type IIIc16.7% (P = 0.001 between groups). Patients who developed infection had a longer mean time from injury to definitive surgery (4.7 vs. 3.9 days, P = 0.03) and from injury to wound closure (13.7 vs. 3.6 days, P < 0.001). Distal fractures had a higher infection rate than midshaft fractures (13.3% vs. 8.2%, P = 0.03). Infection rates were not associated with time from injury to initial debridement, time from injury to initial antibiotic administration, or total duration of antibiotics.
CONCLUSIONS:Open tibia fractures can be managed effectively using the SIGN intramedullary nail in LMICs with an overall infection rate of 11.9%. Risk factors for infection identified include more severe soft-tissue injury, delayed nailing, delayed wound closure, and distal fracture location.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</description><issn>0890-5339</issn><issn>1531-2291</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kMFqGzEQhkVpady0bxCCjr1sKmlXK-mYmjg1ODW07nnRSqNYibxypV1M-vRRcBpCD53LMPDNP8yH0BklF5Qo8eXrenNBXhVtGvoGzSivacWYom_RjEhFKl7X6gR9yPmuQJIw9h6d1EQQxgmdoT8_fL7HC23GmDJ2MeHl4MCMPg740o3wNI9J78BOIej0gL9rH_xwi6PD6z0MeON7rwP-udVuxItUgqYEGfsBr-Khwnqw-MZbG6BaDibuAM_jVBI95I_ondMhw6fnfop-La4282_Van29nF-uKsNkSytoVM-tASW14FpKq7lyqqVMt0L2vdFS1WAE54yLtnaWSts7ZoUWum6IJvUp-nzM3af4e4I8djufDZR3BohT7hgVqpFNK2VBmyNqUsw5gev2ye_K2x0l3ZP1rljv_rVe1s6fL0x9MfWy9FdzAeQROMRQnOb7MB0gdVvQYdz-P_sR7rOOmw</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Whiting, Paul S</creator><creator>Galat, Daniel D</creator><creator>Zirkle, Lewis G</creator><creator>Shaw, Michael K</creator><creator>Galat, Jeremiah D</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201906</creationdate><title>Risk Factors for Infection After Intramedullary Nailing of Open Tibial Shaft Fractures in Low- and Middle-Income Countries</title><author>Whiting, Paul S ; Galat, Daniel D ; Zirkle, Lewis G ; Shaw, Michael K ; Galat, Jeremiah D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2861-e49b5dce98a75a88da59f9612a678bbca893ec75525763fd18dbf2d7a7a340a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Whiting, Paul S</creatorcontrib><creatorcontrib>Galat, Daniel D</creatorcontrib><creatorcontrib>Zirkle, Lewis G</creatorcontrib><creatorcontrib>Shaw, Michael K</creatorcontrib><creatorcontrib>Galat, Jeremiah D</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of orthopaedic trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Whiting, Paul S</au><au>Galat, Daniel D</au><au>Zirkle, Lewis G</au><au>Shaw, Michael K</au><au>Galat, Jeremiah D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Infection After Intramedullary Nailing of Open Tibial Shaft Fractures in Low- and Middle-Income Countries</atitle><jtitle>Journal of orthopaedic trauma</jtitle><addtitle>J Orthop Trauma</addtitle><date>2019-06</date><risdate>2019</risdate><volume>33</volume><issue>6</issue><spage>e234</spage><epage>e239</epage><pages>e234-e239</pages><issn>0890-5339</issn><eissn>1531-2291</eissn><abstract>OBJECTIVES:(1) To determine the infection rate after fixation of open tibial shaft fractures using the Surgical Implant Generation Network (SIGN) intramedullary nail in low- and middle-income countries (LMICs) and (2) to identify risk factors for infection.
DESIGN:Prospective cohort study using an international online database.
SETTING:Multiple hospitals in LMICs worldwide.
PATIENTS/PARTICIPANTS:A total of 1061 open tibia fractures treated with the SIGN nail in LMICs between March 2000 and February 2013.
INTERVENTION:Intravenous antibiotic administration, surgical debridement, and definitive intramedullary nailing within 14 days of injury.
MAIN OUTCOME MEASUREMENTS:Deep or superficial infection at follow-up, implant breakage/loosening, angular deformity >10 degrees, repeat surgery, radiographic union, weight bearing, and ability to kneel.
RESULTS:The overall infection rate was 11.9%. Infection rates by the Gustilo and Anderson classification were type 15.1%, type II12.6%, type IIIa12.5%, type IIIb29.1%, and type IIIc16.7% (P = 0.001 between groups). Patients who developed infection had a longer mean time from injury to definitive surgery (4.7 vs. 3.9 days, P = 0.03) and from injury to wound closure (13.7 vs. 3.6 days, P < 0.001). Distal fractures had a higher infection rate than midshaft fractures (13.3% vs. 8.2%, P = 0.03). Infection rates were not associated with time from injury to initial debridement, time from injury to initial antibiotic administration, or total duration of antibiotics.
CONCLUSIONS:Open tibia fractures can be managed effectively using the SIGN intramedullary nail in LMICs with an overall infection rate of 11.9%. Risk factors for infection identified include more severe soft-tissue injury, delayed nailing, delayed wound closure, and distal fracture location.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>30702501</pmid><doi>10.1097/BOT.0000000000001441</doi></addata></record> |
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| title | Risk Factors for Infection After Intramedullary Nailing of Open Tibial Shaft Fractures in Low- and Middle-Income Countries |
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