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Pressure sores were a modifiable risk factor for infection in neck of femur fractures
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Investigators identified a five-fold increased rate of infection among patients with a neck of femur fracture who underwent hemiarthroplasty compared to patients who underwent internal fixation with a dynamic hip screw, based on results of a presentation scheduled for the 17th EFORT Annual Congress in Geneva.
Richard J. Holleyman, MBBS, MSc, MRCS, and colleagues found 39 patients (1.4%) developed a deep periprosthetic infection up to 1 year after surgery among 2,822 patients they studied who sustained a femoral neck fracture, were admitted to their institution, underwent surgery between January 2009 and June 2015, and had complete data available. Overall, 2,052 women and 770 men with a mean age of 81.3 years were included in the study. Most patients were American Society of Anesthesiologists grade 2 or 3. Overall, 65% of the patients underwent hemiarthroplasty and 35% of patients underwent internal fixation.
Holleyman said the rate of deep infection he and his colleagues found in this series of patients is comparable to what has been reported at other centers in the United Kingdom.
Patient factors related to infection
“We used a statistical model (stepwise multivariate regression) to study patient and surgical factors predicting development of infection. We found that treatment with hemiarthroplasty was associated with a five-fold increase in the risk of developing deep infection as compared to internal fixation (1.9% vs. 0.4%). Among patient factors, only the presence or development of pressure sores on or during admission was significantly associated with an increased (three-times) risk of development of deep infection,” Holleyman told Orthopaedics Today Europe.
In addition to studying the link between patient-related factors and infection, the investigators analyzed the types of isolated pathogens that grew out in the infected cases. The isolated pathogens they found included nine cases of coagulase-negative Staphylococcus, five cases of methicillin-sensitive S. aureus, four cases of Proteus mirabilis and two cases of MRSA.
Growth of mixed pathogens occurred in 16 cases, based on data in the abstract.
Extended hemiarthroplasty surgical time
“The increased rate of infection observed in hemiarthroplasties is also in agreement with similar, large volume studies and is likely related, intuitively, to the longer surgical procedure and more extensive exposure in these operations,” Holleyman said.
Concerning the relationship between pressure sores and the risk of infection, he said, “Pressure sores are seen in more than 4% of all hip fracture admissions and may lead to deep infection both by spread through the blood stream or local propagation. We believe they represent an important modifiable risk factor and further work is now underway to reduce the incidence and progression of pressure sores at our institution.”
The authors are also investigating the impact of blood transfusion and preventative strategies, like high-dose dual antibiotic cement, for hemiarthroplasties. – by Susan M. Rapp
- Reference:
- Holleyman RJ, et al. Poster #3003. Tentatively scheduled to be presented at: 17th EFORT Annual Congress – A combined programme in partnership with swiss orthopaedics; 1-3 June 2016; Geneva.
- For more information:
- Richard J. Holleyman, MBBS, MSc, MRCS, can be reached at Northumbria Healthcare, Newcastle Upon Tyne, 7-8 Silver Fox Way, North Shields NE27 0QJ, United Kingdom; email: r.holleyman@googlemail.com.
Disclosure: Holleyman reports no relevant financial disclosures.