Infection after fracture fixation (IAFF) is one of the most challenging complications in trauma surgery. Sometimes it may result in permanent damage of the part or even amputation of the part. Over the past decades, implant-related bone infections have gained attention. However, they are termed as Prosthetic Joint Infection (PJI), rather than IAFF. However, IAFF has many similarities with PJI, but there are many critical differences in many aspects, including prevention, diagnosis, and treatment.
Infection after orthopaedic surgery to a fracture is a dreadful complication resulting in non-union, loss of functioning, and even amputation. The success rate of treating IAFF is around 70 to 90%. Some studies stated that the incidence of IAFF in the case of closed fractures is approximately 1 to 2%, and in the case of open fractures is around 30%. However, the actual percentage of IAFF is underestimated due to a lack of an exact diagnosis.
Early detection of the condition and interdisciplinary care are mandatory. Elimination of infection is possible only through a combination of surgical and antibiotic treatments. Most fractures may not lead to infections, but the treatment and recovery will be long and complicated when it occurs.
Causes Of Infections After A Fracture Fixation
Typically infections occur after fractures due to the bacteria that enter the body during the traumatic incident. Although it is uncommon, bacteria may also enter into the body while performing surgery to set the fractured bones or during the healing of the injury.
For instance, in case of an open fracture, the bone breaks, and the bone fragments penetrate out through the skin. It is also called a compound fracture. Skin is that it acts as a natural barrier to restrict outside contaminants, including bacteria. But when a fracture happens, the bacteria can easily invade the fracture site, which results in an infection.
However, in some instances, the bacteria can reach the fracture site through the bloodstream, which mostly results in bone fracture infections.
Generally, if the damage to the surrounding skin, muscles, arteries, and veins around the fracture site is high, then the risk of infection is higher.
Some chronic health conditions can also reduce your immune power and may put you at a higher risk of infection after a fracture treatment. Below are some diseases:
- Diabetes mellitus
- Rheumatoid arthritis
The lifestyle choices you make can also influence the risk of the infection. These include smoking, drinking alcohol, and using nicotine products. Some other factors like obesity, poor nutrition, and poor hygiene can also lead to infection after a fracture treatment.
Symptoms Of Infection After A Fracture
In general, an infection after fracture can result in intense pain, fever, redness, and swelling around the fractured area. In some cases, pus sacs are formed and, when they burst, the pus will flow out from the injury. Patients might also experience high fever, chills, and night sweats.
Tests To Diagnose An Infection After A Fracture
Even after the infection seems clear, your orthopaedic surgeon will suggest an x-ray to diagnose the infection’s extent. Blood tests are also recommended to identify the infection;
- WBC (white blood cell count)
- ESR (sedimentation rate)
- CRP (C-reactive protein)
If these tests can’t help to diagnose that you have an infection, the orthopaedic surgeon may advise some other additional tests such as a CT scan, MRI scan, and a tagged white blood cell scan even though this is rare.
If the infection is around the joint, your surgeon uses a needle and draws the fluid from the infectious site. This fluid is sent to the lab and analyzed to determine the presence of bacteria. This is because a healing fracture sometimes shows similar test results like an infection. Sometimes it will become hard for doctors to diagnose the disease after fixing a fracture. It is often up to the doctor’s knowledge and experience to determine whether there is an infection.
Treatment Of Infection After A Fracture
Severe fractures like an open fracture, compound fractures, etc., are treated surgically. You will be given antibiotics from the emergency room itself. The surgeon would clean the wound and remove the infection as much as possible from the skin, muscle tissues, and bone. This process is called debridement and is typically done in the operation room. Depending on the severity of the fracture, it requires numerous debridements and irrigation procedures.
If you are diagnosed with an infection after surgery, initially, it will be treated with antibiotics alone, but sometimes additional surgery is necessary to clean out the infection. During operation, the surgeon takes the infected tissue samples to find the type of bacteria that causes the infection. In case of some rare kind of infections, it might require more than one surgery. The pus is removed from the wound with the help of special drains are placed in the wound. Antibiotic beads may also be used to administer higher antibiotic concentrations at the site of fracture.
The surgeon chooses effective antibiotics for treating the infection after identifying the type of bacteria-infected the wound. An infectious disease specialist might work along the orthopaedic surgeon to find the appropriate antibiotics to treat the infection. Most patients take antibiotics around 6 to 12 weeks.
If the infection affects the bone(bone fracture), it becomes hard to eliminate and might require long-term antibiotic treatment along with several surgeries. Occasionally, in the case of rare infections, some patients might need to take antibiotics for their lifetime.
In very few cases, amputation(removing) of the infected limb might be considered. Amputation is a rare incidence performed only to save the patient’s life in case of severe infection that is out of control.
However, infections are rare after fracture fixation; if it occurs, it might require multiple treatments, including long-term antibiotic treatment, surgical intervention, and a long time to heal. Infections can be treated successfully. An experienced orthopaedic surgeon can understand the anatomy of fracture clearly and be able to provide effective treatment. For more information, contact Dr Vasudeva Juvvadi, one of the best fracture treatment doctors in Hyderabad.