Surgical treatment outcome after serial debridement of infected nonunion—A retrospective cohort study

• Published in: European journal of orthopaedic surgery & traumatology Vol. 32; no. 1; pp. 183 - 189
• Main Authors: Rupp, Markus, Kern, Stefanie, Walter, Nike, Anastasopoulou, Lydia, Schnettler, Reinhard, Heiss, Christian, Alt, Volker
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.01.2022; Springer Nature B.V
• Subjects: Cohort analysis; Debridement; Fractures, Ununited - surgery; Granulocytes; Humans; Infections; Joint surgery; Laboratories; Medical records; Medicine; Medicine & Public Health; Open fractures; Original; Original Article; Orthopedics; Pathogens; Patients; Prospective Studies; Reoperation; Retrospective Studies; Surgical Orthopedics; Transplants & implants; Trauma; Traumatic Surgery; Treatment Outcome; Infection; Debridement; Nonunion; Bone infection; Surgery
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-021-02930-4

Purpose Reported outcome after multiple staged surgical treatment of infected nonunion is scarce. We, therefore, asked: (1) What is the clinical outcome in infected nonunion patients after multiple staged revision surgery? (2) Are different pathogens evidenced after surgical treatment in patients who have undergone more or less surgeries? Methods All enrolled patients were surgically treated for long bone-infected nonunion between January 2010 and March 2018. Besides patients´ demographics outcome in terms of bony consolidation and major complications defined as death during inward treatment, amputation and recurrence of infection during follow-up of at least 12 months were assessed. Microbiological findings were assessed and compared between two groups with less than five versus five or more surgical revisions. Results Bone consolidation was achieved in 86% of the patients while complications such as femoral or transtibial amputation, recurrence of infection or even death during inpatient treatment could be evidenced in six patients (14%). In patients who underwent multiple-stage surgery for five or more times, germ changes and repeated germ detection was more common than in patients with less surgeries. Conclusions Surgical treatment of infected nonunions poses a high burden on the patients with major complications occurring in about 14% of the patients using a multiple staged treatment concept. Future prospective studies comparing outcomes after limited with multiple staged revision surgeries are necessary.