Treatment of post-operative infections following proximal femoral fractures: Our institutional experience

Theodorides, A.A.; Pollard, T.C.B.; Fishlock, A.; Mataliotakis, G.I.; Kelley, T.; Thakar, C.; Willett, K.M.; Giannoudis, P.V.

doi:10.1016/S0020-1383(11)70130-9

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Volume 42, Supplement 5 , Pages S28-S34, December 2011

Treatment of post-operative infections following proximal femoral fractures: Our institutional experience

A.A. Theodorides
- Academic Department of Trauma and Orthopaedic Surgery, Leeds General Infirmary, University of Leeds, Leeds, UK
T.C.B. Pollard
- Oxford Trauma Unit, The John Radcliffe Hospital, and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
A. Fishlock
- Academic Department of Trauma and Orthopaedic Surgery, Leeds General Infirmary, University of Leeds, Leeds, UK
G.I. Mataliotakis
- Academic Department of Trauma and Orthopaedic Surgery, Leeds General Infirmary, University of Leeds, Leeds, UK
T. Kelley
- Oxford Trauma Unit, The John Radcliffe Hospital, and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
C. Thakar
- Oxford Trauma Unit, The John Radcliffe Hospital, and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
K.M. Willett
- Oxford Trauma Unit, The John Radcliffe Hospital, and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
P.V. Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, Leeds General Infirmary, University of Leeds, Leeds, UK
- Corresponding author. Peter V. Giannoudis MD, FRCS, Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, LIMM Section Musculoskeletal Disease, Leeds, LS1 3EX, UK. Tel.: +44 113 392 2750; fax: +44 113 292 3290

Abstract

Proximal femoral fractures (PFFs) are a major health concern in the elderly population. Improvements made in implants and surgical techniques resulted in faster rehabilitation and shorter length of hospital stay. Despite this, the reduced physiological reserve, associated co-morbidities and polypharmacy intake of the elderly population put them at high risk of postoperative complications particularly of infectious origin.

Out of 10061 patients with proximal femoral fractures 105 (1.05%) developed surgical site infection; 76 (72%) infections occurred in patients who had sustained intracapsular (IC) fractures with the remaining 29 (28%) infections occurring in patients with extracapsular (EC) neck of femur fractures. The median number of additional surgical debridements was 2 (range 1–7). MRSA was isolated in 49 (47%) of the cases; 38 patients (36%) ultimately underwent a Girdlestone's excisional arthroplasty.

Mortality at 30 days and 3 months was 10% and 31%, respectively. It was noted that post-operative hip infection predisposed to a prolonged length of stay in the acute unit and subsequently to a more dependent destination after discharge.

Keywords: Proximal femoral fracture , Neck of femur fracture , Infection , Treatment , Cost

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