Treatment of infection following intramedullary nailing of tibial shaft fractures-results of the ORS/ISFR expert group survey.

  • Mauffrey Cyril
  • Hak David J.
  • Giannoudis Peter
  • Alt Volker
  • Nau Christoph
  • Marzi Ingo
  • Augat Peter
  • Oh J. K.
  • Frank Johannes
  • Mavrogenis Andreas
  • Flecher Xavier
  • Argenson Jean-Noël
  • Gavaskar Ashok
  • Rojas David
  • Bedeir Yehia H.

  • Humans
  • Treatment Outcome
  • Intramedullary nailing
  • Nonunion tibia
  • Survey on nonunion
  • Tibia fractures
  • Tibia infection
  • Treatment algorithm
  • Cellulitis/etiology/therapy
  • Fracture Fixation
  • Intramedullary/adverse effects
  • Health Care Surveys
  • Osteomyelitis/etiology/therapy
  • Surgical Wound Infection/etiology/therapy
  • Tibial Fractures/surgery

ART

OBJECTIVE: The lack of universally accepted treatment principles and protocols to manage infected intramedullary (IM) nails following tibial fractures continues to challenge us, eliciting a demand for clear guidelines. Our response to this problem was to create an ORS/ISFR taskforce to identify potential solutions and trends based on published evidence and practices globally. MATERIALS AND METHODS: A questionnaire of reported treatment methods was created based on a published meta-analysis on the topic. Treatment methods were divided in two groups: A (retained nail) and B (nail removed). Experts scored the questionnaire items on a scale of 1-4 twice, before and after revealing the success rates for each stage of infection. Inter- and intra-observer variability analysis among experts' personal scores and between experts' scores was performed. An agreement mean and correlation degree between experts' scores was calculated. Finally, a success rate report between groups was performed. RESULTS: Experts underestimated success rate of an individual treatment method compared to published data. The mean difference between experts' scores and published results was + 26.3 ± 46 percentage points. Inter-observer agreement mean was poor (\textless 0.2) for both rounds. Intra-observer agreement mean across different treatment methods showed a wide variability (18.3 to 64.8%). Experts agree more with published results for nail removal on stage 2 and 3 infections. CONCLUSIONS: Experts' and published data strongly agree to retain the implant for stage 1 infections. A more aggressive approach (nail removal) favoured for infection stages 2 and 3. However, literature supports both treatment strategies. EVIDENCE: Clinical Question.