Infections after osteosynthesis of lower extremity long bones: etiology, classification and diagnosis
Abstract
Infections after osteosynthesis are difficult to manage and impair fracture healing. While relatively rare fractures become infected after surgical treatment, it is often challenging to obtain a rapid diagnosis. Optimal management strategies should be complex and highly customized. At present, there is no high level of relevant evidence; most literature data are based on laboratory and nonrandomized clinical studies. This article presents the overview of recent literature concerning pathogenesis, diagnosis and classification of infections after osteosynthesis.
About the Authors
P. A. VolotovskiBelarus
A. A. Sitnik
Belarus
A. V. Beletsky
Belarus
References
1. Aggarwal VK, Higuera C, Deirmengian G, Parvizi J, Austin MS. Swab cultures are not as effective as tissue cultures for diagnosis of periprosthetic joint infection. ClinOrthopRelatRes2013;471:3196–203.
2. Arens S, Kraft C, Schlegel U, et al (1999) Susceptibility to local infection in biological internal fixation. Experimental study of open vs minimally invasive plate osteosynthesis in rabbits. Arch Orthop Trauma Surg; 119(1-2):82−85.
3. Burns TC, Stinner DJ, Mack AW, Potter BK, Beer R, Eckel TT, et al. Microbiology and injury characteristics in severe open tibia fractures from combat. J Trauma AcuteCareSurg2012;72:1062–7.
4. Cierny III G, Mader J, Penninck J. The classic: a clinical staging system for adult osteomyelitis. Clin Orthop 2003;414:7–24.
5. Conterno LO, da Silva Filho CR. Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst Rev. 2009; 3:1-30.
6. Darouiche RO (2001) Device-associated infections: a macroproblem that starts with microadherence. Clin Infect Dis; 33(9):1567−1572.
7. E. Johnson, R. Buckley R. Chronic infection and infected nonunion. In: Rüedi T, Buckley R, Moran C, editors. AO Principles of Fracture Management: Thieme; 2008. p. 543–55.
8. Greenwood-Quaintance KE, Uhl JR, Hanssen AD, Sampath R, Mandrekar JN, Patel R. Diagnosis of prosthetic joint infection by use of PCR-electrospray ionization massspectrometry. JClinMicrobiol2014;52:642–9.
9. Gustilo RB, Gruninger RP, Davis T (1987) Classification of type III (severe) open fractures relative to treatment and results. Orthopedics; 10(12):1781−1788.
10. Hudson MC, Ramp WK, Nicholson NC, Williams AS, Nousiainen MT. Internalization of Staphylococcus aureus by cultured osteoblasts. Microb Pathog 1995; 19: 409–19.
11. Kremers HM, Nwojo ME, Ransom JE. et al. Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009. J Bone Joint Surg Am. 2015;97:837–45.
12. Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am. 2004; 86:2305-2318.
13. Ledermann HP, Kaim A, Bongartz G, Steinbrich W. Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis. Eur Radiol 2000;10:1815–23.
14. Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004; 364:369-379.
15. Lipsky BA, Berendt AR: XVI Osteomyelitis. American College of Physicians Medicine 2010; 7 Inf Dis, XVI: 1–20.
16. Love C, Palestro CJ. Nuclear medicine imaging of bone infections. Clin Radiol 2016.
17. Malekzadeh D, Osmon DR, Lahr BD, Hanssen AD, Berbari EF. Prior use of antimicrobial therapy is a risk factor for culture-negative prosthetic joint infection. ClinOrthopRelatRes 2010;468:2039–45.
18. O’May GA, Brady RA, Prabhakara R, Leid JG, Calhoun JH, Shirtliff ME: Osteomyelitis. Biofilm Infections 2011: 111–37.
19. Ochsner PE, Hailemariam S. Histology of osteosynthesis associated bone infection. Injury 2006;37(Suppl 2):S49–58.
20. Ochsner PE, Sirkin MS. Acute infection. In: Rüedi TP, Buckley RE, Moran CG (Hrsg.). AO principles of fracture management. AO Publishing, Thieme, Stuttgart 2007
21. Panousis K, Grigoris P, Butcher I, Rana B, Reillyl JH, Hamblen DL. Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases.ActaOrthop2005;76:341–6.
22. Pasquaroli S, Zandri G, Vignaroli C, Vuotto C, Donelli G, Biavasco F. Antibiotic pressure can induce the viable but nonculturable state in Staphylococcus aureus growing in biofilms. J Antimicrob Chemother 2013;68:1812–7.
23. Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg 2005;13:417–27.
24. Penn-Barwell JG, Bennett PM, Fries CA, Kendrew JM, Midwinter MJ, Rickard RF. Severe open tibial fractures in combat trauma: management and preliminary outcomes. Bone Joint J. 2013; 95:101-105.
25. Perry CR. A historical perspective. In: Bone and Joint Infections. London: Martin Dunitz; 1996:1-8.
26. Schenker ML, Yannascoli S, Baldwin KD, Ahn J, Mehta S. Does timing to operative debridement affect infectious complications in open long bone fractures? A systematic review. J Bone Joint Surg Am. 2012; 94:1057-1064.
27. Schmidt HG, Tiemann AH, Braunschweig R, et al.: Zur Definition der Diagnose Osteomyelitis-Osteomyelitis-Diagnose-Score (ODS). Z Orthop Unfall 2011; 149: 449–60.
28. Schultz M: Microscopic investigation in fossil hominoidea: a clue to taxonomy, functional anatomy, and the history of diseases. The Anatomical Record 1999; 257: 225–32.
29. Schwotzer N, Wahl P, Fracheboud D, Gautier E, Chuard C. Optimal culture incubation time in orthopedic device-associated infections: a retrospective analysis of prolonged 14-day incubation. JClinMicrobiol2014;52:61–6.
30. Senneville E, Joulie D, Legout L, Valette M, Dezeque H, Beltrand E, et al. Outcome and predictors of treatment failure in total hip/knee prosthetic joint infections due to Staphylococcus aureus. ClinInfectDis2011;53:334–40.
31. Sheehy SH, Atkins BA, Bejon P, et al. The microbiology of chronic osteomyelitis: prevalence of resistance to common empirical antimicrobial regimens. J Infect. 2010; 60:338343.
32. Steinhausen E, Glombitza M, Bohm HJ, Hax PM, Rixen D. Non-unions: from diagnosis tohealing.Unfallchirurg2013;116:633– 47quiz48-9.
33. Stewart PS, Costerton JW (2001) Antibiotic resistance of bacteria in biofilms. Lancet; 358(9276):135−138.
34. Trampuz A, Osmon DR, Hanssen AD, et al (2003) Molecular and antibiofilm approaches to prosthetic joint infection. Clin Orthop; 414:69−88.
35. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. New Engl J Med 2007;357:654–63.
36. Trampuz A, Zimmerli W: Diagnosis and treatment of infections associated with fracture-fixation devices. Injury 2006; 37 Suppl 2: 59–66.
37. Vandecasteele SJ, Peetermans WE, Merckx R, Van Eldere J. Expression of biofilm-associated genes in Staphylococcus epidermidis during in vitro and in vivo foreign body infections. J Infect Dis 2003; 188: 730–37.
38. Vaudaux P, Francois P, Lew DP, Waldvogel FA. Host factors predisposing to and influencing therapy of foreign body infections. In: Waldvogel FA, Bisno AL, eds. Infections associated with indwelling medical devices, 3rd edn. Washington: ASM Press, 2000: 1–26.
39. Veeh RH, Shirtliff ME, Petik JR, Flood JA, Davis CC, Seymour JL, et al. Detection of Staphylococcus aureus biofilm on tampons and menses components. J Infect Dis2003;188:519–30.
40. Wenter V, Muller JP, Albert NL, Lehner S, Fendler WP, Bartenstein P, et al. The diagnostic value of [(18)F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection. Eur J Nucl Med Mol Imaging 2016;43:749– 61.
41. Willenegger H, Roth B. Treatment tactics and late results in early infection following osteosynthesis. Unfallchirurgie 1986;12:241–6.
42. Willey M, Karam M. Impact of infection on fracture fixation. Orthop Clin North Am2016;47:357–64.
43. Zimmerli W, Lew PD, Waldvogel FA (1984) Pathogenesis of foreign body infection: Evidence for a local granulocyte defect. J Clin Invest; 73(4):1191−1200.
44. Zimmerli W, Waldvogel FA, Vaudaux P, et al (1982) Pathogenesis of foreign body infection: description and characteristics of an animal model. J Infect Dis; 146(4):487−497.
Review
For citations:
Volotovski P.A., Sitnik A.A., Beletsky A.V. Infections after osteosynthesis of lower extremity long bones: etiology, classification and diagnosis. Military Medicine. 2018;(1):83-89. (In Russ.)
JATS XML