Histological assessment of the presence or absence of infection in fracture non-union

• Published in: Injury Vol. 33; no. 2; pp. 151 - 155
• Main Authors: Simpson, A.H.R.W, Wood, M.K, Athanasou, N.A
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.03.2002; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections - complications; Bacterial Infections - diagnosis; Bacterial Infections - pathology; Bacteriological Techniques; Biological and medical sciences; Child; Child, Preschool; Female; Fractures, Ununited - microbiology; Fractures, Ununited - pathology; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Neutrophil Infiltration; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity; Surgical Wound Infection - complications; Surgical Wound Infection - diagnosis; Surgical Wound Infection - pathology; Traumas. Diseases due to physical agents; Mal union; Human; Diseases of the osteoarticular system; Fracture; Trauma; Bacteriological investigation; Infection; Pathology; Sensitivity; Specificity; Microbiological investigation; Etiology; Predictive value; Complication; Diagnosis
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/S0020-1383(01)00078-X

Background: Infection is a major cause of non-unions. Infection is not always evident clinically, nor on bacteriological analysis. If it is untreated, non-union treatment may fail. Aim: To establish whether histological analysis is of value as an adjunct to microbiology in establishing the diagnosis of infection. Methods: Sixty patients who had both bacteriological and histological analysis of their non-unions were studied. Infection was indicated by an acute inflammatory response. In 45 of the 60 fractures, microbiological and clinical diagnoses were in agreement; in this subset the histology results were compared to the established diagnoses. Results: The histological diagnosis for the 45 fractures in the group with a definite diagnosis gave four false negatives but no false positives. This represents a sensitivity of 87.1%, (95% CI, 70–96%) and a 100% specificity (95% CI, 77–100%). The overall accuracy was 91.1%. (95% CI, 79–98%) The predictive value of a positive test was 100% and of a negative test was 77.8%. In 25% of the series a definite diagnosis could not be made with purely clinical and microbiological information; with the additional histological information it was possible to determine the infection status of the non-union. Conclusion: Histology is of particular use when the microbiology is negative or equivocal.