TY - JOUR
T1 - Infected hardware after surgical stabilization of rib fractures
T2 - Outcomes and management experience
AU - Thiels, Cornelius A.
AU - Aho, Johnathon M.
AU - Naik, Nimesh D.
AU - Zielinski, Martin D.
AU - Schiller, Henry J.
AU - Morris, David S.
AU - Kim, Brian D.
N1 - Funding Information:
Support was provided by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Thiels) and by the NHLBI grant T32 HL105355 from the National Heart, Lung, and Blood Institute, a component of the National Institutes of Health (Aho).
Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/2/17
Y1 - 2016/2/17
N2 - BACKGROUND: Surgical stabilization of rib fracture (SSRF) is increasingly used for treatment of rib fractures. There are few data on the incidence, risk factors, outcomes, and optimal management strategy for hardware infection in these patients. We aimed to develop and propose a management algorithm to help others treat this potentially morbid complication. METHODS: We retrospectively searched a prospectively collected rib fracture database for the records of all patients who underwent SSRF from August 2009 through March 2014 at our institution. We then analyzed for the subsequent development of hardware infection among these patients. Standard descriptive analyses were performed. RESULTS: Among 122 patients who underwent SSRF, most (73%) were men; the mean (SD) age was 59.5 (16.4) years, and median (interquartile range [IQR]) Injury Severity Score was 17 (13-22). The median number of rib fractures was 7 (5-9) and 48% of the patients had flail chest. Mortality at 30 days was 0.8%. Five patients (4.1%) had a hardware infection on mean (SD) postoperative day 12.0 (6.6). Median Injury Severity Score (17 [range, 13-42]) and hospital length of stay (9 days [6-37 days]) in these patients were similar to the values for those without infection (17 days [range, 13Y22 days] and 9 days [6-12 days], respectively). Patients with infection underwent a median (IQR) of 2 (range, 2-3) additional operations, which included wound debridement (n = 5), negative-pressurewound therapy (n = 3), and antibiotic beads (n = 4). Hardwarewas removed in 3 patients at 140, 190, and 192 days after index operation. Cultures grew only gram-positive organisms. No patients required reintervention after hardware removal, and all achieved bony union and were taking no narcotics or antibiotics at the latest follow-up. CONCLUSIONS: Although uncommon, hardware infection after SSRF carries considerable morbidity.With the use of an aggressive multimodal management strategy, however, bony union and favorable long-term outcomes can be achieved.
AB - BACKGROUND: Surgical stabilization of rib fracture (SSRF) is increasingly used for treatment of rib fractures. There are few data on the incidence, risk factors, outcomes, and optimal management strategy for hardware infection in these patients. We aimed to develop and propose a management algorithm to help others treat this potentially morbid complication. METHODS: We retrospectively searched a prospectively collected rib fracture database for the records of all patients who underwent SSRF from August 2009 through March 2014 at our institution. We then analyzed for the subsequent development of hardware infection among these patients. Standard descriptive analyses were performed. RESULTS: Among 122 patients who underwent SSRF, most (73%) were men; the mean (SD) age was 59.5 (16.4) years, and median (interquartile range [IQR]) Injury Severity Score was 17 (13-22). The median number of rib fractures was 7 (5-9) and 48% of the patients had flail chest. Mortality at 30 days was 0.8%. Five patients (4.1%) had a hardware infection on mean (SD) postoperative day 12.0 (6.6). Median Injury Severity Score (17 [range, 13-42]) and hospital length of stay (9 days [6-37 days]) in these patients were similar to the values for those without infection (17 days [range, 13Y22 days] and 9 days [6-12 days], respectively). Patients with infection underwent a median (IQR) of 2 (range, 2-3) additional operations, which included wound debridement (n = 5), negative-pressurewound therapy (n = 3), and antibiotic beads (n = 4). Hardwarewas removed in 3 patients at 140, 190, and 192 days after index operation. Cultures grew only gram-positive organisms. No patients required reintervention after hardware removal, and all achieved bony union and were taking no narcotics or antibiotics at the latest follow-up. CONCLUSIONS: Although uncommon, hardware infection after SSRF carries considerable morbidity.With the use of an aggressive multimodal management strategy, however, bony union and favorable long-term outcomes can be achieved.
KW - Flail chest
KW - Hardware infection
KW - Rib fracture
KW - SSRF
KW - Surgical stabilization
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U2 - 10.1097/TA.0000000000001005
DO - 10.1097/TA.0000000000001005
M3 - Article
C2 - 26891160
AN - SCOPUS:84958817483
SN - 2163-0755
VL - 80
SP - 819
EP - 823
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -