medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2021, Number 2

<< Back Next >>

Acta Ortop Mex 2021; 35 (2)

Symptomatic osteosynthesis in calcaneal fracture: implant colonization as a cause of pain

Machuca-Novoa M, Corcoll F, González-Lucena G, Bianco D, Alier-Fabregó A, Pérez-Prieto D, Ginés-Cespedosa A

Language: Spanish
References: 16
Page: 137-141
PDF size: 157.41 Kb.


ABSTRACT

Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.


REFERENCES

  1. Mitchell MJ, McKinley JC, Robinson CM. The epidemiology of calcaneal fractures. Foot (Edinb). 2009; 19(4): 197-200.

  2. Bostman O, Pihlajamaki H. Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J Trauma. 1996; 41(5): 846-9.

  3. Backes M, Schepers T, Beerekamp MSH, et al. Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach. Int Orthop. 2014; 38(4): 767-73.

  4. Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma. 2001; 15(4): 271-4.

  5. Harvey EJ, Grujic L, Early JS, Benirschke SK, Sangeorzan BJ. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int. 2001; 22(11): 868-73.

  6. Makki D, Alnajjar H, Walkay S, Ramkumar U, Watson AJ, Allen P. Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Joint Surg Br. 2010; 92(5): 693-700.

  7. Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Medicine. 2007; 357(7): 654-63.

  8. Portillo ME, Salvadó M, Trampuz A, et al. Improved diagnosis of orthopedic implant-associated infection by inoculation of sonication fluid into blood culture bottles. J Clin Microbiol. 2015; 53(5): 1622-7.

  9. Krenn V, Morawietz L, Perino G, et al. Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract. 2014; 210(12): 779-86.

  10. Govaert GAM, Kuehl R, Atkins BL, et al. Diagnosing fracture-related infection: current concepts and recommendations. J Orthop Trauma. 2020; 34(1): 8-17.

  11. De Groot R, Frima AJ, Schepers T, et al. Complications following the extended lateral approach for calcaneal fractures do not influence mid- to long-term outcome. Injury. 2013; 44(11): 1596-600.

  12. Backes M, Schep NWL, Luitse JSK, Goslings JC, Schepers T. Indications for implant removal following intra-articular calcaneal fractures and subsequent complications. Foot Ankle Int. 2013; 34(11): 1521-5.

  13. Knabl L, Kuppelwieser B, Mayr A, et al. High percentage of microbial colonization of osteosynthesis material in clinically unremarkable patients. Microbiologyopen. 2019; 8(3): e00658.

  14. Patzakis M, Zalavras C. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg. 2005; 13(6): 417-27.

  15. Metsemakers WJ, Kuehl R, Moriarty TF, et al. Infection after fracture fixation: Current surgical and microbiological concepts. Injury. 2018; 49(3): 511-22.

  16. Puig-Verdié L, Alentorn-Geli E, González-Cuevas A, et al. Implant sonication increases the diagnostic accuracy of infection in patients with delayed, but not early, orthopaedic implant failure. Bone Joint J. 2013; 95-B(2): 244-9.



EVIDENCE LEVEL

IV




2020     |     www.medigraphic.com