Postoperative infection in patients undergoing inspection of orthopedic damage due to external fixation

Foni, Noel Oizerovici; Batista, Felipe Augusto Ribeiro; Rossato, Luís Henrique Camargo; Hungria, José Octavio Soares; Mercadante, Marcelo Tomanik; Christian, Ralph Walter

doi:10.1016/j.rboe.2015.10.011

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ORIGINAL ARTICLE • Rev. bras. ortop. 50 (6) • Nov-Dec 2015 • https://doi.org/10.1016/j.rboe.2015.10.011 copy

Postoperative infection in patients undergoing inspection of orthopedic damage due to external fixation ^☆ ☆ Work performed in the Trauma Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To conduct a retrospective analysis on cases undergoing inspection of orthopedic damage, at an orthopedic emergency service in a teaching hospital, with the aim of evaluating patients with postoperative infection after conversion to internal osteosynthesis.

METHODS:

This was a retrospective analysis covering the period from June 2012 to June 2013, on patients who underwent inspection of orthopedic damage due to external fixation and subsequently were converted to definitive osteosynthesis using a nail or plate.

RESULTS:

We found an infection rate of 13.3% in our sample and, furthermore, found that there had been technical errors in setting up the fixator in 60.4% of the cases.

CONCLUSION:

We found an infection rate that we considered high, along with inadequacies in constructing the external fixator. We emphasize that this procedure is not risk-free and that training for physicians who perform this procedure should be mandatory.

Keywords:
Infection; External fixators; Internal fracture fixation

Case	Attending physician 1	Attending physician 2	R2a	R2b	R3a	R3b
1	Inadequate	Adequate	Inadequate	Inadequate	Adequate	Inadequate
2	Inadequate	Adequate	Inadequate	Adequate	Adequate	Inadequate
3	Adequate	Adequate	Adequate	Adequate	Adequate	Adequate
4	Inadequate	Inadequate	Inadequate	Inadequate	Inadequate	Adequate
5	Inadequate	Inadequate	Inadequate	Inadequate	Inadequate	Adequate
6	Adequate	Adequate	Inadequate	Inadequate	Adequate	Inadequate
7	Inadequate	Adequate	Adequate	Inadequate	Inadequate	Inadequate
8	Inadequate	Inadequate	Inadequate	Inadequate	Inadequate	Inadequate
9	Inadequate	Inadequate	Inadequate	Inadequate	Inadequate	Inadequate
10	Adequate	Inadequate	Inadequate	Inadequate	Adequate	Inadequate
11	Inadequate	Adequate	Inadequate	Inadequate	Inadequate	Inadequate
12	Inadequate	Adequate	Adequate	Adequate	Inadequate	Inadequate
13	Adequate	Adequate	Inadequate	Adequate	Adequate	Adequate
14	Adequate	Adequate	Adequate	Adequate	Adequate	Adequate
15	Inadequate	Adequate	Inadequate	Inadequate	Adequate	Inadequate
16	Inadequate	Inadequate	Inadequate	Inadequate	Adequate	Inadequate

Name	Sex	Age	Fracture location	Gustilo	External fixator	Pin number	Distance from pin to definitive synthesis	Presence of multiple drilled holes	Time taken until conversion
1	M	19	Lower leg	3A	Transarticular over ankle	4	6 cm		30 days
2	M	73	Lower leg	3A	Transarticular over knee	4	5 cm		14 days
3	M	43	Lower leg	3A	Linear on lower leg	4	3.2 cm (locking screw)	x	14 days
4	M	19	Lower leg	3A	Linear on lower leg	4	1.5 cm (locking screw)	x	6 days
5	M	36	Lower leg	3A	Linear on lower leg	4	4.3 cm (locking screw)	x	9 days
6	M	24	Femur	3A	Tube-to-tube on femur	4	1 cm	x	21 days
7	M	33	Humerus	3A	Transarticular over elbow	4	0	x	10 days
8	M	24	Femur + lower leg	3A	Transarticular over knee	8	0		5 days
9	M	56	Lower leg	3A	Linear on lower leg	6	0	x	21 days
10	M	37	Plateau	0	Transarticular over knee	4	0	x	13 days
11	M	31	Femur + knee	3A	Transarticular over knee	8	0	x	15 days
12	F	81	Ankle	0	Transarticular over ankle	4	0		15 days
13	F	71	Ankle	0	Transarticular over ankle	4	5 cm		6 days
14	M	25	Lower leg	0	Linear on lower leg	4	5 cm (locking screw)		10 days
15	F	74	Tibial diaphysis + fibula	0	Transarticular over ankle	4	3.5 cm		21 days
16	M	49	Plateau	0	Transarticular over knee	4	0		10 days

Number of evaluators	Total number of cases (%)	Number of adequate cases	Number of inadequate cases
6 evaluators	4 (25)	2	2
5 evaluators	5 (31.3)	2	3
4 evaluators	4 (25)	0	5
3 evaluators	3 (18.7)	3	3

Evaluator	Number of adequate cases (%)	Number of inadequate cases (%)
1	5 (31.3)	11 (68.7)
2	10 (62.5)	6 (37.5)
3	9 (56.2)	7 (43.8)
4	5 (31.3)	11 (68.7)
5	4 (25)	12 (75)
6	5 (31.3)	11 (68.7)
Total	38 (39.6)	58 (60.4)

Evaluator	Number of adequate cases (%)	Number of inadequate cases (%)
Attending physician	15 (46.9)	17 (53.1)
R3	14 (43.7)	18 (56.3)
R2	9 (28.1)	23 (71.9)
Total	38 (39.6)	58 (60.4)

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author . E-mail:noelfoni@hotmail.com(N.O. Foni).

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Postoperative infection in patients undergoing inspection of orthopedic damage due to external fixation ☆ ☆ Work performed in the Trauma Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Postoperative infection in patients undergoing inspection of orthopedic damage due to external fixation ^☆ ☆ Work performed in the Trauma Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.