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Treatment Approach for Infection of Healed Fractures After Internal Fixation

Lawrenz, Joshua M. MD; Frangiamore, Salvatore J. MD; Rane, Ajinkya A. MD; Cantrell, William Alex BS; Vallier, Heather A. MD

doi: 10.1097/BOT.0000000000000929
Original Article

Objective: To review the efficacy of a treatment approach for patients with infection and colonized implants after open reduction and internal fixation of fractures.

Design: Retrospective case series.

Setting: Level one trauma center.

Patients: Twenty patients were treated for wound infection with colonized implants after open reduction and internal fixation.

Intervention: Surgical debridement, removal of implants, and a short postoperative oral antibiotic course.

Main Outcome Measurement: The course of patients after surgical debridement and removal of implants, including culture results, antibiotic administration, and presence of recurrent clinical infection and radiographic union.

Results: Twenty patients had clinical presentations, including skin breakdown, serous drainage, purulent drainage and/or exposed implants, most commonly of the tibia (15 of 20). Mean time from index procedure to debridement with implant removal was 19.7 months. At the time of debridement and implant removal, 18 of 20 (90%) patients had a positive intraoperative culture (16 routine cultures and 2 broth cultures). The most common bacteria were Enterobacter cloacae (5/17) and methicillin-sensitive Staphylococcus aureus (4/17). All patients had soft tissue healing without signs of recurrent infection after mean follow up of 40 months after implant removal.

Conclusions: Surgical debridement with implant removal plus a short oral antibiotic course is effective to resolve wound infection with a colonized implant in the setting of healed fracture after internal fixation.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.

Reprints: Heather A. Vallier, MD, Department of Orthopaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 (e-mail:

The authors report no conflict of interest.

Presented in part at the Annual Meeting of the Orthopaedic Trauma Association, October 8, 2015, San Diego, CA.

Accepted June 08, 2017

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