Infectious Complications of Damage Control Orthopedics in War Trauma
- 1 October 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal Of Trauma-Injury Infection and Critical Care
- Vol. 67 (4), 758-761
- https://doi.org/10.1097/ta.0b013e3181af6aa6
Abstract
War-trauma, especially due to blast injury, can be associated with long bone fracture. Immediate external fixation of fractures, followed by internal fixation when the patient is medically stabilized (damage control orthopedics [DCO]), is the U.S. Army policy for war-related fractures. Data on infectious outcomes when DCO is used for war-trauma fractures are scant. A retrospective review of U.S. war-trauma patients from 2003 to 2007 with femoral or tibial fractures treated by DCO was conducted. Fisher's Exact and Mann-Whitney tests were used for comparisons. Fifty-eight soldiers were identified. Fifty-five were males with a median age of 26 years (19-54 years) and a median time to internal fixation by intramedually nailing of 9 days (4-414 days). Eighty-eight percent of fractures were open, and 57% were femoral fractures. The median duration of follow-up was 447 days (20-1,340 days). Fracture site infection occurred in 40% (23 of 58), with suspected osteomyelitis in 17% (10 of 58). Of infected nails, fracture union occurred in 70% and nail retention in 57%. Median time to infection after nail placement was 15 days (0-717 days) with 75% of infections occurring by day 113. Multiple bacterial pathogens including Acinetobacter baumannii and Staphylococcus spp. were causative organisms. Blast injuries occurred in 91% of infected versus 47% of uninfected (p = 0.005). There was no difference between infections occurring in femoral (61%) versus tibial (39%) (p = 0.620) location. Infection was associated with 40% of DCO-associated intramedullary nails. Blast injury was a predictor of infection. Despite infection, fracture union and nail retention rates were high, suggesting a good outcome.Keywords
This publication has 8 references indexed in Scilit:
- Osteomyelitis in Military Personnel Wounded in Iraq and AfghanistanJournal Of Trauma-Injury Infection and Critical Care, 2008
- Infectious Complications of Open Type III Tibial Fractures among Combat CasualtiesClinical Infectious Diseases, 2007
- The Risk of Local Infective Complications After Damage Control Procedures for Femoral Shaft FractureJournal of Orthopaedic Trauma, 2006
- Intramedullary Nailing Following External Fixation in Femoral and Tibial Shaft FracturesJournal of Orthopaedic Trauma, 2005
- Casualties of War — Military Care for the Wounded from Iraq and AfghanistanNew England Journal of Medicine, 2004
- Conversion of External Fixation to Intramedullary Nailing for Fractures of the Shaft of the Femur in Multiply Injured Patients*The Journal of Bone and Joint Surgery-American Volume, 2000
- Problems in the Management of Type III (Severe) Open FracturesJournal Of Trauma-Injury Infection and Critical Care, 1984
- Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bonesThe Journal of Bone & Joint Surgery, 1976