In the Journals

History of surgery, open fracture linked with higher risk of infection after treatment for nonunion

Of patients with a history of surgery or open fracture, 20% treated for nonunions had positive intraoperative cultures from the definitive surgery, according to results.

Researchers treated 666 consecutive nonunions between 1999 and 2009. Of these, 453 cases were considered at risk for indolent infection due to a history of surgery, infection or an open fracture. Primary outcome measures included radiographic union and infection after the index reconstructive procedure, and the need for additional surgery to gain union.

Overall, despite negative inflammatory markers, 91 cases (20%) had ‘surprise’ positive cultures. According to results, the most common bacterium isolated was coagulase-negative Staphylococcus. Researchers considered eight of the 91 cultures (9%) probable contaminants and provided no antibiotics, while the other 83 patients received antibiotics. Results showed five of the patients who did not receive antibiotics healed. Of the patients who received antibiotics, 80% initially healed and 14% remained infected. Compared with 86% of patients who were not grafted, researchers noted 82% of patients treated with augmentation healed. – by Casey Tingle

Disclosures: Olszewski reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

Of patients with a history of surgery or open fracture, 20% treated for nonunions had positive intraoperative cultures from the definitive surgery, according to results.

Researchers treated 666 consecutive nonunions between 1999 and 2009. Of these, 453 cases were considered at risk for indolent infection due to a history of surgery, infection or an open fracture. Primary outcome measures included radiographic union and infection after the index reconstructive procedure, and the need for additional surgery to gain union.

Overall, despite negative inflammatory markers, 91 cases (20%) had ‘surprise’ positive cultures. According to results, the most common bacterium isolated was coagulase-negative Staphylococcus. Researchers considered eight of the 91 cultures (9%) probable contaminants and provided no antibiotics, while the other 83 patients received antibiotics. Results showed five of the patients who did not receive antibiotics healed. Of the patients who received antibiotics, 80% initially healed and 14% remained infected. Compared with 86% of patients who were not grafted, researchers noted 82% of patients treated with augmentation healed. – by Casey Tingle

Disclosures: Olszewski reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.