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Analyzing risk factors for treatment failure in fracture-related infection

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Fracture-related infection (FRI) represents a challenging clinical scenario. Limited evidence exists regarding treatment failure after initial management of FRI. The objective of our investigation was to determine incidence and risk factors for treatment failure in FRI.

Materials and methods

We conducted a retrospective review of patients treated for FRI between 2011 and 2015 at three level 1 trauma centers. One hundred and thirty-four patients treated for FRI were identified. Demographic and clinical variables were extracted from the medical record. Treatment failure was defined as the need for repeat debridement or surgical revision seven or more days after the presumed final procedure for infection treatment. Univariate comparisons were conducted between patients who experienced treatment failure and those who did not. Multivariable logistic regression was conducted to identify independent associations with treatment failure.

Results

Of the 134 FRI patients, 51 (38.1%) experienced treatment failure. Patients who failed were more likely to have had an open injury (31% versus 17%; p = 0.05), to have undergone implant removal (p = 0.03), and additional index I&D procedures (3.3 versus 1.6; p < 0.001). Most culture results identified a single organism (62%), while 15% were culture negative. Treatment failure was more common in culture-negative infections (p = 0.08). Methicillin-resistant Staphylococcus aureus (MRSA) was the most common organism associated with treatment failure (29%; p = 0.08). Multivariate regression demonstrated a statistically significant association between treatment failure and two or more irrigation and debridement (I&D) procedures (OR 13.22, 95% CI 4.77–36.62, p < 0.001) and culture-negative infection (OR 4.74, 95% CI 1.26–17.83, p = 0.02).

Conclusions

The rate of treatment failure following FRI continues to be high. Important risk factors associated with treatment failure include open fracture, implant removal, and multiple I&D procedures. While MRSA remains common, culture-negative infection represents a novel risk factor for failure, suggesting aggressive treatment of clinically diagnosed cases remains critical even without positive culture data.

Level of evidence

Retrospective cohort study; Level III.

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Funding

The work of this study was not supported by external funding sources.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Taylor M. Yong, Michael B. Sparks & Ida L. Gitajn

  2. Geisel School of Medicine, Dartmouth College, Hanover, NH, USA

    Forrest A. Rackard, Michael B. Sparks & Ida L. Gitajn

  3. Department of Orthopedics, Naval Hospital, Jacksonville, Jacksonville, FL, USA

    Lauren K. Dutton

  4. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Mitchel B. Harris

Authors
  1. Taylor M. Yong
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  2. Forrest A. Rackard
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  3. Lauren K. Dutton
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  6. Ida L. Gitajn
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Correspondence to Taylor M. Yong.

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The requirement of informed consent was waived in this retrospective, minimal-risk study.

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Yong, T.M., Rackard, F.A., Dutton, L.K. et al. Analyzing risk factors for treatment failure in fracture-related infection. Arch Orthop Trauma Surg 143, 1387–1392 (2023). https://doi.org/10.1007/s00402-021-04277-1

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  • DOI: https://doi.org/10.1007/s00402-021-04277-1

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