Alizé Dabert , Adrien Runtz , Grégoire Leclerc , Pauline Sergent , François Loisel , Isabelle Pluvy , Thomas Fradin , Patrick Garbuio
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The study hypothesis was that bone consolidation is possible under septic conditions without hardware exchange.</p></div><div><h3>Material and method</h3><p>A single-center retrospective observational study was conducted on 69 patients for the period January 1, 2009 to December 31, 2019. We included all patients aged over 15 years with infection after internal fixation or fusion whose files had been discussed in the multidisciplinary team meeting during the study period. Bone healing was screened for on X-ray or CT. Study data comprised type of fracture, smoking status, time to treatment<span><span> for open fracture, initial surgery time, type of hardware, interval between fixation and revision, and type of irrigation. Functional results were assessed at follow-up: walking, pain, return to work and </span>SF12<span> and QuickDASH scores.</span></span></p></div><div><h3>Results</h3><p>The bone healing rate was 73.5% (50/68 patients) at a mean 24 weeks (range, 6–68 weeks).</p><p>Time to revision did not significantly impact consolidation: 60% for 2 weeks (6/10 cases), 80% for 2−10 weeks (35/40 cases), and 64% for >10 weeks (9/14 cases) (p = 0.28). Smoking, longer initial surgery time and Gustilo type IIIb or IIIc were significant risks factors for non-consolidation.</p></div><div><h3>Discussion</h3><p>Bone consolidation under septic conditions with hardware retention adhering to an established medical and surgical protocol was reliable and straightforward, without extra morbidity. These findings are encouraging, and in line with the literature. We were unable to determine a time limit beyond which hardware prevented healing.</p></div><div><h3>Level of evidence</h3><p>IV; descriptive epidemiological study.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Bone consolidation under septic condition and hardware retention: about 69 patients\",\"authors\":\"Alizé Dabert , Adrien Runtz , Grégoire Leclerc , Pauline Sergent , François Loisel , Isabelle Pluvy , Thomas Fradin , Patrick Garbuio\",\"doi\":\"10.1016/j.otsr.2024.103942\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Management of infection on internal fixation hardware is particularly complex.</p><p>The main aim of the present study was to assess bone consolidation rates under septic conditions in patients treated for bone and joint infection (BJI) with hardware retention. Secondary objectives were to determine a time limit beyond which it is unreasonable to retain hardware, and to assess risk factors for non-consolidation and functional results. The study hypothesis was that bone consolidation is possible under septic conditions without hardware exchange.</p></div><div><h3>Material and method</h3><p>A single-center retrospective observational study was conducted on 69 patients for the period January 1, 2009 to December 31, 2019. We included all patients aged over 15 years with infection after internal fixation or fusion whose files had been discussed in the multidisciplinary team meeting during the study period. Bone healing was screened for on X-ray or CT. Study data comprised type of fracture, smoking status, time to treatment<span><span> for open fracture, initial surgery time, type of hardware, interval between fixation and revision, and type of irrigation. Functional results were assessed at follow-up: walking, pain, return to work and </span>SF12<span> and QuickDASH scores.</span></span></p></div><div><h3>Results</h3><p>The bone healing rate was 73.5% (50/68 patients) at a mean 24 weeks (range, 6–68 weeks).</p><p>Time to revision did not significantly impact consolidation: 60% for 2 weeks (6/10 cases), 80% for 2−10 weeks (35/40 cases), and 64% for >10 weeks (9/14 cases) (p = 0.28). Smoking, longer initial surgery time and Gustilo type IIIb or IIIc were significant risks factors for non-consolidation.</p></div><div><h3>Discussion</h3><p>Bone consolidation under septic conditions with hardware retention adhering to an established medical and surgical protocol was reliable and straightforward, without extra morbidity. These findings are encouraging, and in line with the literature. 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引用次数: 0
摘要
前言内固定硬件感染的处理尤为复杂。本研究的主要目的是评估骨与关节感染（BJI）患者在脓毒症条件下保留硬件治疗的骨巩固率。次要目的是确定保留硬件不合理的时限，并评估不固结的风险因素和功能结果。研究假设是，在化脓性条件下，不更换硬件也能实现骨整合：2009年1月1日至2019年12月31日期间，对69名患者进行了单中心回顾性观察研究。我们纳入了所有年龄超过 15 岁的内固定或融合术后感染患者，研究期间多学科小组会议讨论了他们的病例。骨愈合通过 X 光或 CT 进行筛查。研究数据包括骨折类型、吸烟状况、开放性骨折的治疗时间、初次手术时间、硬件类型、固定和翻修的间隔时间以及灌洗类型。随访时对功能结果进行评估：行走、疼痛、重返工作岗位、SF12和QuickDASH评分：结果：在平均24周（6-68周）时，骨愈合率为73.5%（50/68例患者）。翻修时间对巩固率没有明显影响：2周的巩固率为60%（6/10例），2-10周的巩固率为80%（35/40例），大于10周的巩固率为64%（9/14例）（P=0.28）。吸烟、初始手术时间较长、Gustilo IIIb或IIIc型是导致不固结的重要危险因素：讨论：在脓毒性条件下，按照既定的医疗和手术方案进行硬件保留的骨整合是可靠和直接的，没有额外的发病率。这些发现令人鼓舞，与文献报道一致。我们无法确定硬件阻碍愈合的时限：证据级别：IV；描述性流行病学研究。
Bone consolidation under septic condition and hardware retention: about 69 patients
Introduction
Management of infection on internal fixation hardware is particularly complex.
The main aim of the present study was to assess bone consolidation rates under septic conditions in patients treated for bone and joint infection (BJI) with hardware retention. Secondary objectives were to determine a time limit beyond which it is unreasonable to retain hardware, and to assess risk factors for non-consolidation and functional results. The study hypothesis was that bone consolidation is possible under septic conditions without hardware exchange.
Material and method
A single-center retrospective observational study was conducted on 69 patients for the period January 1, 2009 to December 31, 2019. We included all patients aged over 15 years with infection after internal fixation or fusion whose files had been discussed in the multidisciplinary team meeting during the study period. Bone healing was screened for on X-ray or CT. Study data comprised type of fracture, smoking status, time to treatment for open fracture, initial surgery time, type of hardware, interval between fixation and revision, and type of irrigation. Functional results were assessed at follow-up: walking, pain, return to work and SF12 and QuickDASH scores.
Results
The bone healing rate was 73.5% (50/68 patients) at a mean 24 weeks (range, 6–68 weeks).
Time to revision did not significantly impact consolidation: 60% for 2 weeks (6/10 cases), 80% for 2−10 weeks (35/40 cases), and 64% for >10 weeks (9/14 cases) (p = 0.28). Smoking, longer initial surgery time and Gustilo type IIIb or IIIc were significant risks factors for non-consolidation.
Discussion
Bone consolidation under septic conditions with hardware retention adhering to an established medical and surgical protocol was reliable and straightforward, without extra morbidity. These findings are encouraging, and in line with the literature. We were unable to determine a time limit beyond which hardware prevented healing.
期刊介绍：
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.
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