Debridement, Fracture Related Infection, Implant Removal/Replacement, Implant Retention, Orthopedic Surgery
Conditions
Keywords
orthopedic surgery, fracture-related infection, debridement, implant retention, implant removal/replacement
Brief summary
This study aims to compare the clinical outcomes of debridement, antibiotics, and implant retention (DAIR) and implant removal/replacement methods used in the treatment of fracture-related infections, and to determine the infection-free fracture healing rates and the factors affecting treatment success.
Detailed description
Fracture-related infection remains one of the most challenging musculoskeletal complications in orthopedic trauma surgery. Its diagnosis is a multi-stage process based on various diagnostic criteria. The international consensus definition of fracture-related infection was standardized in 2018, and this definition has been reinforced with updates in subsequent years. The recently validated consensus definition of fracture-related infection offers clinicians the opportunity to standardize clinical reports and improve the quality of published literature. The consensus definition definitively indicates the presence of infection \[confirmatory criteria; (1) fistula/sinus tract/incision site dehiscence, (2) purulent drainage during surgery, (3) growth of the same pathogen in ≥2 separate deep tissue/implant cultures\] or possibly indicates the presence of infection \[suggestive criteria; The diagnostic criteria are based on (1) local pain, redness, increased heat, (2) wound exudation, (3) fever, (4) elevated CRP and ESR, (5) implant loosening, osteolysis, non-union. The presence of suggestive criteria should raise suspicion of infection, and further investigation should be conducted. The presence of at least one confirmatory sign is associated with high diagnostic performance and is pathognomonic for the presence of fracture-related infection. This definition also guides the treatment of fracture-related infections. Fracture-related infections are a significant complication causing high morbidity in orthopedic trauma surgery. This study aims to compare the clinical outcomes of DAIR and implant removal/replacement methods used in the treatment of fracture-related infections, and to determine the infection-free fracture healing rates and the factors affecting treatment success.
Interventions
OTHERDAIR
DAIR: Debridement, antibiotic retention and implant removal
OTHERImplant removal/replacement
implant removal/replacement
Sponsors
Antalya Health Sciences University
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* internal fixation after fracture * presence of fistula and/or sinus tract or purulent drainage with dehiscence at the incision site * at least 2 positive deep tissue cultures or at least 3 positive soft tissue cultures * early onset of symptoms (6 weeks) * DAIR or implant removal/replacement due to fracture-related infection
Exclusion criteria
* Under 18 years old patients * prosthetic joint infection * only conservative treatment applied * pathological fracture due to primary bone tumor * simultaneous infection foci in the same extremity * fracture-related infection not confirmed by international consensus criteria * poor reduction after internal fixation * inappropriate or inadequate internal fixation * radiological images less than 1 year old * findings starting late (after 6 weeks)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fracture healing rates | 1 year | Infection-free fracture healing rates |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Recurrence rate | 1 year | Infection recurrence rate |
| Union time | 1 year | Time to union |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORMelih Unal
University of Health Sciences, Antalya Training and Research Hospital
Outcome results
None listed