Can infection be predicted after intramedullary nailing of tibial shaft fractures?

Abstract

Despite the progress in tibial fracture care, some patients contract infection following intramedullary nailing. We analyzed which risk factors could predict infection in 171 tibial fractures. The independent variables included age, gender, body mass index, and comorbidities, along with external factors of fracture pattern, nailing settings, and treatment processing time. A multiple logistic regression was used to identify infection risk factors.

The risk of infection significantly increased according to the open grading, the fractures’ classification, time until antibiotic administration, and time until nailing. Gustilo type I fractures presented a higher rate of infection than expected, explained by a longer delay before surgery. The probabilistic equation allows infection prediction with high sensitivity and specificity. In total, we showed that no antibiotics’ prescription in emergency service and a transverse fracture pattern were predictors of infection. An infection risk score can be computed, aiding surgeons in decision making. Outcomes could improve keeping these observations in mind.

Level of evidence: Retrospective cohort study. Level iii.