[Septic complications after multilocal fractures and multiple traumatic injury].

Abstract

Introduction: The increase of the number of the multiple traumatic injuries is related to social factors, such as: the development of industry, the change of life style and the conditions of work, the manner and the speed of relocation and the biological factors related with the elongation of life time. According to the World Health Organization data the injuries are one of the main health problems in the world.

Aim: The clinical analysis of multitrauma patients treated due to the septic complications of the fractures.

Material and methods: The material consists of 34 multitrauma patients treated in The Osteomyelitis and Septic Complications Unit in Prof. A. Gruca Orthopedic and Trauma Hospital in Otwock, Poland between 2005 and 2010. The cause of trauma, the timing of arrival to our unit, the number of the days of treatment, the number and the specificity of bone and internal injuries, the bacteriology of bone infections and operative techniques and pharmacologic treatment were analyzed.

Results: The causes of the injuries were: road accident (79%), fall from the height (8.8%), others (12.2%). The first stay in our unit was 21 months after the injury on average (1-129 months), the number of stays in the unit was 2,8 on average (1-6), the length of stay was 25.7 days on average (4-108 days). In analyzed group of 34 patients, we found: 12 opened fractures of single bone, 11 opened fractures of more than one bone, 22 closed fractures of single bone, 12 closed fracture of more than one bone. Central nervous system (55.9%), abdominal organs (35.3%) and thorax (29.4%) were the most common internal organs ocuppied with the injury. Osteomyelitis was the most frequently diagnosed in femur (50%) and tibia (41.2%). The main reasons of bone infection were: Methycylin-Sensitive Staphylococcus Aureus (35,3%), Methycylin-Resistant Staphylococcus Aureus (17,3%), Pseudomonas aeruginosa (23,5%), Escherichia coli, Acinetobacter baumani, Enterococcus faecalis. The following treatment was undertaken: the debridement of septic bone, usually together with the removal of the hardware stabilization (73,5%), the removal of the damaged or improperly fixed stabilization (44%), the conversion of the internal fixation into the external fixation(62%). All the patients were taken intravenous antibiotics according to The Hospital Commission for Preventing of Infections, i.e. 2nd generation cephalosporin and gentamycin. Culture directed antibiotics were started after receiving the bacteriology results. The outcomes. The control of infection in 14 patients (41.3%), 18 patients (52.9%) still remain under the treatment, bad outcome (persistent infection, amputation of a extremity) we had in 2 patients.

Conclusions: Multiple traumatic injury and its immunologic consequences predispose to systemic infections including bone infections. Posttraumatic osteomyelitis is the indication to chronic treatment. Surgical management of the wound and external fixation of the fractures of the long bones according to the control damage surgery is the most important in prevention of posttraumatic osteomyelitis.