Abstract
Tibial fracture management may be complicated by infection of internal fixation hardware (iIFH) resulting in increased morbidity and amputation rate. When iIFH removal is not possible, salvage of the lower extremity is attempted through debridement, antibiotics, and vascularized soft tissue coverage. This study investigates lower extremity salvage with retention of iIFH. Demographics, outcomes, and bacterial speciation in patients with tibial fractures at a level 1 trauma center from 2007 to 2014 were reviewed. The primary outcome was infection suppression, while secondary outcomes included limb salvage, amputation, and osseous union. Twenty-five patients underwent soft tissue reconstruction for salvage of iIFH. Average age was 41, 19 (76%) were male, average BMI 30.1 kg/m2 , 10 (40%) patients smoked. Tibial fractures were closed in 8 (32%), Gustilo-Anderson grade I in 1 (4%), II in 8 (32%), IIIb in 5 (20%), and IIIc in 1 (4%). Staphylococcus was most commonly cultured with 11 (44%) demonstrating methicillin-resistance. Soft tissue reconstruction was performed by local flap in 15 (60%) and free flap in 10 (40%). At an average of 16.1 months, 19 (76%) hardware salvage patients demonstrated clinical suppression of infection, 11 o...Continue Reading
References
Sep 1, 1986·Plastic and Reconstructive Surgery·M Godina
Jul 1, 1994·Spine·B K KlinkJ E Cain
Jul 1, 1996·Plastic and Reconstructive Surgery·B H WindleM S Beckenstein
Jan 26, 1999·Clinical Orthopaedics and Related Research·M Y NahabedianD S Hungerford
Nov 30, 1999·Plastic and Reconstructive Surgery·M Y NahabedianD S Hungerford
Dec 4, 2002·Annals of Plastic Surgery·Jeffrey A GusenoffMaurice Y Nahabedian
Feb 20, 2003·Journal of Bacteriology·Philip S Stewart
Oct 25, 2006·Annals of Plastic Surgery·C Scott HultmanGrant W Carlson
Mar 28, 2008·Biotechnology and Bioengineering·James D Bryers
Dec 24, 2008·Journal of Orthopaedic Trauma·Anthony M HarrisUNKNOWN Lower Extremity Assessment Project (LEAP) Study Group
Feb 24, 2009·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Robert W MendicinoAlan R Catanzariti
Apr 3, 2010·The Journal of Bone and Joint Surgery. American Volume·Marschall BerkesUNKNOWN Southeast Fracture Consortium
Sep 12, 2012·Annals of Plastic Surgery·Ketan M PatelIvica Ducic
Aug 16, 2013·Microsurgery·Gen WenL V Yi-Min
Nov 2, 2013·Journal of Biomedical Materials Research. Part a·Hao ChengWei Xiong
May 13, 2014·Journal of Biomedical Materials Research. Part B, Applied Biomaterials·Magdalena ZaborowskaMargarita Trobos
Oct 5, 2014·Clinics in Podiatric Medicine and Surgery·Geoffrey G Hallock
Oct 8, 2014·Antimicrobial Agents and Chemotherapy·Yang LiKerong Dai
Dec 20, 2014·Biomaterials·Mark T EhrensbergerAnthony A Campagnari
Jan 19, 2015·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·N HøibyUNKNOWN ESCMID Study Group for Biofilms and Consulting External Expert Werner Zimmerli
Apr 29, 2015·Acta Biomaterialia·Vincenzo TarescoAntonella Piozzi
Jan 6, 2016·Microsurgery·Lingyun XiongChristoph Hirche
Mar 29, 2016·Microsurgery·Farid BekaraBenoit Chaput