Surgical and microbiological characteristics that influence the probability of reoperation to promote bone healing after fracture-related infection diagnosis

PurposeTo compare the surgical and microbiological characteristics of fracture related infection (FRI) that had union and those requiring additional surgery to promote bone healing. We hypothesized that FRIs with MRSA will have higher risk for reoperation to promote bone healing.MethodsThis is a retrospective study on 247 patients over 18 who underwent bone fixation for pelvis, upper, and lower extremities fractures between 2013 and 2021 at a level I trauma center. All cases had an FRI and at least 6 months of follow-up after diagnosis. Patients with pathologic fracture due to underlying malignancy and patients with spinal fractures were excluded. We compared surgical and microbiological characteristics of fractures between cases that required reoperation to promote bone healing and those who did not.ResultsOf 247 patients, 55 (22.2%) required reoperations to promote bone healing after diagnosis of FRI. Patients that received topical antibiotics at closure during initial fixation had higher risk for reoperations to promote bone healing (30.8% vs. 15.2%, p = 0.049). Infection with Pseudomonas aeruginosa was associated with a lower risk for reoperations to promote bone healing (0%, p = 0.040). Rates of patients requiring reoperations to promote bone healing in infections with MRSA were similar to infections with MSSA (19.6% vs 20.9%, p = 1.000) and other pathogens (19.6% vs 23%; p = 0.539). Open fracture (OR 0.785, p = 0.534), tobacco use (OR 0.557, p = 0.126), upper extremity (OR 0.730, p = 0.534) or use of topical antibiotic at closure (OR 0.439, p = 0.067) did not increase risk for reoperation to promote bone healing.ConclusionUsing topical antibiotics for skin closure during initial fixation for bone fractures may increase the risk of reoperation to promote bone healing, while infection with P. aeruginosa decreases the risk. Infection with MRSA or MSSA did not increase risk for requiring reoperation to promote bone healing after FRI diagnosis. Further studies should examine the impact of topical antibiotics during fracture surgery on development of FRI.