Abstract
Introduction
Prosthetic joint infection (PJI) after femoral neck fracture is associated with a
higher mortality, morbidity and economic costs. Although is well known that the presence
of a postsurgical haematoma is associated with infection, in our knowledge there are
no articles evaluating the contamination of the femoral neck fracture haematoma and
the possible relationship with early postoperative PJI. The aim of our study was to
evaluate the prevalence of positive cultures from haematoma in patients with femoral
neck fracture and the relationship with early PJI.
Methods
A prospective observational study was performed. All patients who underwent hip hemiarthroplasty
for a femoral neck fracture from April’08 to February’09 were included. Three samples
were taken just after the arthrotomy, a tissue sample, a swab of haematoma and blood
of haematoma inoculated into blood culture flasks. Patients received the standard
prophylaxis.
Results
A total of 109 patients were treated during this period in our center, 16 were excluded
for mistakes during taking samples or for receiving extra antibiotic treatment after
or before the surgery of the fracture. In 29 patients (31.2%) one or more intraoperative
cultures were positive. Four patients developed an early PJI caused by Gram-negative
bacilli (GNB) in all cases. The early PJI rate in the group of patients with negative
intraopertive cultures was 3.1% while in the group with one or more positive cultures
was 6.9% (p = 0.3). In 3 cases the haematoma was contaminated with a GNB. The PJI rate in patients
with intraoperative cultures positive for a GNB was 66.6% (2/3) while in the group
of patients without a GNB the infection rate was 2.2% (2/89, p = 0.004, Fisher exact-test). Furthermore in these two patients the microorganism that
caused the PJI was the same that had been isolated from the haematoma.
Conclusion
The haematoma in femoral neck fractures was contaminated in 31.2% of cases before
surgery. The contamination of the haematoma with a GNB was associated with a higher
risk of early postoperative PJI.
Keywords
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References
- Infection of a traumatic pelvic hematoma with Mycoplasma hominis.Sex Transm Dis. 1978; 5: 65-67
- Infection associated with hematoma formation after shoulder arthroplasty.Clin Orthop Relat Res. 2008; 466: 1363-1367
- Anterior mediastinal abscess after closed sternal fracture.J Trauma. 1999; 47: 551-554
- Early infection after hip fracture surgery: risk factors, costs and outcome.J Bone Joint Surg Br. 2008; 90: 770-777
- Blood culture flasks for culturing synovial fluid in prosthetic joint infections.Clin Orthop Relat Res. 2010; 17
- Early return to surgery for evacuation of a postoperative hematoma after primary total knee arthroplasty.J Bone Joint Surg Am. 2008; 90: 2331-2336
- Use of blood culture vial specimens in intraoperative detection of infection.Clin Orthop Relat Res. 2001; : 222-231
- Rehabilitation of the hemiplegic patient: a clinical evaluation.South Med J. 1955; 48: 472-480
- Antibiotic resistance in orthopaedic surgery: acute knee prosthetic joint infections due to extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae.Eur J Clin Microbiol Infect Dis. 2010;
- Acute purulent mediastinitis and sternal osteomyelitis after closed chest cardiopulmonary resuscitation: a case report and review of the literature.Ann Thorac Surg. 1988; 46: 353-355
- What's new in the management of proximal femoral fractures?.Injury. 2008; 39: 1309-1318
- Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults.Cochrane Database Syst Rev. 2006; : CD001708
- Deep wound infection after proximal femoral fracture: consequences and costs.J Hosp Infect. 2006; 63: 133-139
- Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program.J Orthop Res. 2002; 20: 506-515
- Usefulness of teicoplanin for preventing methicillin-resistant Staphylococcus aureus infections in orthopedic surgery.Eur J Clin Microbiol Infect Dis. 2006; 25: 35-38
- Bacteriology of callus of closed fractures of tibia and femur.J Trauma. 2008; 65: 837-842
- Diagnosis and management of infection after total knee arthroplasty.J Bone Joint Surg Am. 2003; 85-A: S75-S80
- Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections.J Bone Joint Surg Am. 1996; 78: 512-523
- Arthroplasty or internal fixation for displaced femoral neck fractures: which is the optimal alternative for elderly patients? A meta-analysis.Int Orthop. 2009; 33: 1179-1187
Article info
Publication history
Accepted:
September 6,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
