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Indian Journal of Orthopaedics Surgery


Post-operative infection at fracture site with implant in situ- Managed by retention of Infected implant till attainment of bony union- Our experience


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Author Details: SPS Gill, Manish Raj, Pulkesh Singh, Dinesh Kumar, Jasveer Singh, Prateek Rastogi

Volume : 1

Issue : 4

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 205

Article End Page : 210


Abstract

Introduction: Early Internal fixation of any fracture now days given us great advantage with relation to early mobilization and early returns to daily activity. Rate of infection related to implant surgery reported by numerous study ranges from 0.5% to 4-5% in closed fractures and up to 10% in cases of compound fractures. Post operative infection with implant in place is one of the most difficult conditions to manage. In our study we tried to retain the implants in these cases and evaluated long term result in these cases.
Material and method: We selected total 88 cases of infected implant without union from regular follow cases of operated post operative cases of upper and lower limb long bones managed by nailing and plating April 2011 to August 2014. Out of 88 cases 80 cases completed their follow up duration. We managed these cases with retention of implant for as long as possible with regular debridement, incision and drainage, pus culture and sensitivity and antibiotics accordingly off and on till attainment of bony union. Final results were evaluated and any implant failure and other revision surgery rates recorded.
Results: Out of 80 cases bony union were achieved in 65 cases (81%) with retention of same implant with proper antibiotic coverage, regular follow up and guarded weight bearing. 15(19%) of our cases shows implant failure due to delayed and non union and most of these cases were of comp Grade III & II to start with. In these cases, removal of implant was required before bony union. Infection related to implant was also cured once implant were removed after attaining bony union without any long term complications.
Conclusion: This increase incidence of infection related to implant also aggravated by various drug resistant microorganism. In most of these cases of infected implant, implants can be retained in situ till bony union achieved. Compromised host condition and diffuse Osteo-myelitis according to Cierny-Madar classifaication had given poor outcome with infected implant retention. Low grade infection with implant didn't have any severe negative consequence on bony union. This implant related infection can be cured with removal of implant once bony union achieved. 


Keywords:
Post operative infection, infected implant, Retained infected implant, Infected non union