Stephen A Adesina, Isaac O Amole, Akinsola I Akinwumi, Adepeju O Adegoke, James I Owolabi, Imri G Adefokun, Adewumi O Durodola, Olufemi T Awotunde, Samuel U Eyesan
{"title":"感染并发锁定髓内钉治疗开放性下肢骨折:发病率,相关危险因素,以及在低资源环境下改善预后的经验教训","authors":"Stephen A Adesina, Isaac O Amole, Akinsola I Akinwumi, Adepeju O Adegoke, James I Owolabi, Imri G Adefokun, Adewumi O Durodola, Olufemi T Awotunde, Samuel U Eyesan","doi":"10.5194/jbji-8-71-2023","DOIUrl":null,"url":null,"abstract":"<p><p><b>Introduction</b>: Infection is the chief complication that makes open fractures difficult to treat. Most low- and middle-income countries (LMICs) are missing out on modern management techniques developed to achieve better outcomes in high-income countries (HICs). One of these is the use of locked intramedullary (IM) nails. This study aimed to determine the factors associated with infection of open fractures treated with the surgical implant generation network (SIGN) nail at a Nigerian tertiary hospital. <b>Methods</b>: Data were collected prospectively on 101 open fractures of the femur and tibia over an 8-year period. Active surveillance for infection was done on each patient. Infection was diagnosed as the presence of wound breakdown or purulent discharge from (or near) the wound or surgical incision. Potential risk factors were tested for association with infection. <b>Results</b>: There were 101 fractures in 94 patients with a mean age of 37.76 years. The following treatment-related factors demonstrated significant associations with infection - timings of antibiotic administration (<math><mrow><mi>p</mi><mi><</mi><mn>0.001</mn></mrow></math>) and definitive fracture fixation (<math><mrow><mi>p</mi><mo>=</mo><mn>0.002</mn></mrow></math>); definitive wound closure (<math><mrow><mi>p</mi><mi><</mi><mn>0.001</mn></mrow></math>), fracture-reduction methods (<math><mrow><mi>p</mi><mo>=</mo><mn>0.005</mn></mrow></math>), and surgery duration (<math><mrow><mi>p</mi><mo>=</mo><mn>0.007</mn></mrow></math>). <b>Conclusions</b>: Although this study has limitations precluding the drawing up of final conclusions, the findings suggest that the risk factors for infection of nailed open fractures in LMICs are similar to those in HICs. Consequently, outcomes can potentially improve if LMICs adopt the management principles used in HICs in scientifically sound ways that are affordable and socially acceptable to their people. Further studies are suggested to establish our findings.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106765/pdf/","citationCount":"0","resultStr":"{\"title\":\"Infection complicating locked intramedullary nailing of open lower-extremity fractures: incidence, associated risk factors, and lessons for improving outcome in a low-resource setting.\",\"authors\":\"Stephen A Adesina, Isaac O Amole, Akinsola I Akinwumi, Adepeju O Adegoke, James I Owolabi, Imri G Adefokun, Adewumi O Durodola, Olufemi T Awotunde, Samuel U Eyesan\",\"doi\":\"10.5194/jbji-8-71-2023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Introduction</b>: Infection is the chief complication that makes open fractures difficult to treat. Most low- and middle-income countries (LMICs) are missing out on modern management techniques developed to achieve better outcomes in high-income countries (HICs). One of these is the use of locked intramedullary (IM) nails. This study aimed to determine the factors associated with infection of open fractures treated with the surgical implant generation network (SIGN) nail at a Nigerian tertiary hospital. <b>Methods</b>: Data were collected prospectively on 101 open fractures of the femur and tibia over an 8-year period. Active surveillance for infection was done on each patient. Infection was diagnosed as the presence of wound breakdown or purulent discharge from (or near) the wound or surgical incision. Potential risk factors were tested for association with infection. <b>Results</b>: There were 101 fractures in 94 patients with a mean age of 37.76 years. The following treatment-related factors demonstrated significant associations with infection - timings of antibiotic administration (<math><mrow><mi>p</mi><mi><</mi><mn>0.001</mn></mrow></math>) and definitive fracture fixation (<math><mrow><mi>p</mi><mo>=</mo><mn>0.002</mn></mrow></math>); definitive wound closure (<math><mrow><mi>p</mi><mi><</mi><mn>0.001</mn></mrow></math>), fracture-reduction methods (<math><mrow><mi>p</mi><mo>=</mo><mn>0.005</mn></mrow></math>), and surgery duration (<math><mrow><mi>p</mi><mo>=</mo><mn>0.007</mn></mrow></math>). <b>Conclusions</b>: Although this study has limitations precluding the drawing up of final conclusions, the findings suggest that the risk factors for infection of nailed open fractures in LMICs are similar to those in HICs. Consequently, outcomes can potentially improve if LMICs adopt the management principles used in HICs in scientifically sound ways that are affordable and socially acceptable to their people. Further studies are suggested to establish our findings.</p>\",\"PeriodicalId\":15271,\"journal\":{\"name\":\"Journal of Bone and Joint Infection\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2023-02-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106765/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Bone and Joint Infection\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5194/jbji-8-71-2023\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bone and Joint Infection","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5194/jbji-8-71-2023","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Infection complicating locked intramedullary nailing of open lower-extremity fractures: incidence, associated risk factors, and lessons for improving outcome in a low-resource setting.
Introduction: Infection is the chief complication that makes open fractures difficult to treat. Most low- and middle-income countries (LMICs) are missing out on modern management techniques developed to achieve better outcomes in high-income countries (HICs). One of these is the use of locked intramedullary (IM) nails. This study aimed to determine the factors associated with infection of open fractures treated with the surgical implant generation network (SIGN) nail at a Nigerian tertiary hospital. Methods: Data were collected prospectively on 101 open fractures of the femur and tibia over an 8-year period. Active surveillance for infection was done on each patient. Infection was diagnosed as the presence of wound breakdown or purulent discharge from (or near) the wound or surgical incision. Potential risk factors were tested for association with infection. Results: There were 101 fractures in 94 patients with a mean age of 37.76 years. The following treatment-related factors demonstrated significant associations with infection - timings of antibiotic administration () and definitive fracture fixation (); definitive wound closure (), fracture-reduction methods (), and surgery duration (). Conclusions: Although this study has limitations precluding the drawing up of final conclusions, the findings suggest that the risk factors for infection of nailed open fractures in LMICs are similar to those in HICs. Consequently, outcomes can potentially improve if LMICs adopt the management principles used in HICs in scientifically sound ways that are affordable and socially acceptable to their people. Further studies are suggested to establish our findings.