The role of sonication in microbiology culture yield of the explanted infected implants post fracture fixation: A systematic review

Objective To evaluate the role of sonication in cases of postoperative infection following fracture fixation. Methods A systematic review of studies comparing peri-implant tissue culture (PTC) and sonication fluid culture (SFC) from implants removed due to fracture-related infection was conducted. The inclusion criteria were: published in English, human studies, implants from fracture-related infection, and tests comparing the culture of deep tissue and sonication fluid. The quality of studies was assessed using the Critical Appraisal Skill Program (CASP) tool. The sensitivity, specificity, implant preservation mechanism to avoid contamination, cost, and duration of incubation for PTC and SFC were extracted and compared using descriptive statistics. Results Nine studies with a total of 1,144 participants were included. The overall mean sensitivity of SFC and PTC was 88.9% (95% CI: 84.6-92.4%) and 67.8% (95% CI: 60.9-74.2%), respectively. While the specificity of SFC and PTC was 96.2% (95% CI: 94.7-97.4%) and 98.5% (95% CI: 97.7-99.0%), respectively. However, the cost-effectiveness of sonication as a diagnostic method for sonication remains unclear, as only one study estimated the price of sonication to be $228.00 per test, similar to PTC. Conclusions Sonication fluid culture might improve sensitivity in diagnosing postoperative infection following fracture fixation. This technique can potentially enhance the microbiological output and provide valuable guidance to healthcare professionals in treating infection after fracture fixation. However, more high-quality trials are needed to establish its optimal use, especially cost-effectiveness. Registration The study protocol was registered on PROSPERO (CRD42022338190; 18 June 2022).