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What's in a nail?
1Department of Orthopedic Surgery, University of Louisville, Kentucky 40207.
Abstract:
To determine the incidence of subclinical infection using routine swab methods in asymptomatic patients, 30 consecutive hollow intramedullary nails were studied. Variables identified were leukocyte count and differential, patient complaints, time elapsed from injury to nail implantation, duration of nail implantation, and the size of the nail. Specimens were gathered from the lumen of intramedullary nails using the routine swab method for bacterial culture as well as fungal and acid-fast growth. This material was also subjected to pathologic review with routine hematoxylin and eosin staining. There were no significant positive cultures in this study. The pathologic review indicated that the material in the canal of an intramedullary nail was either granulation tissue, fibrous tissue, or osseous tissue. No patient had a deep or superficial wound infection after implant removal. The results of this study indicate that the material in the lumen of the hollow intramedullary nail will fail to grew organisms when the swab method is used in gathering the specimen or the material is sent for quantitative bacteriology.
Insights
Routine swab methods in asymptomatic patients did not detect subclinical infections in hollow intramedullary nails. Pathologic review confirmed the absence of microbial growth, suggesting low infection risk with this diagnostic approach.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Medical Microbiology
Background:
- Subclinical infections in orthopedic implants can complicate patient recovery.
- Hollow intramedullary nails are commonly used for fracture fixation.
- Assessing infection in asymptomatic patients requires reliable diagnostic methods.
Purpose of the Study:
- To evaluate the incidence of subclinical infection in asymptomatic patients with hollow intramedullary nails.
- To determine the efficacy of routine swab methods for detecting microbial presence in nail lumens.
- To correlate patient factors and implant characteristics with potential infection.
Main Methods:
- Prospective study of 30 consecutive hollow intramedullary nails in asymptomatic patients.
- Specimen collection via routine swab from the nail lumen for bacterial, fungal, and acid-fast cultures.
- Pathologic review of collected material using hematoxylin and eosin staining.
- Analysis of variables including leukocyte count, patient complaints, and implant details.
Main Results:
- No significant positive microbial cultures were obtained from any intramedullary nail specimens.
- Pathologic examination revealed granulation tissue, fibrous tissue, or osseous tissue, but no organisms.
- No deep or superficial wound infections were observed post-implant removal.
- The swab method and quantitative bacteriology failed to detect microbial growth.
Conclusions:
- Routine swab methods are insufficient for detecting subclinical infections within hollow intramedullary nails in asymptomatic patients.
- The material within the nail lumen typically consists of host tissue rather than infectious agents.
- Further investigation into more sensitive diagnostic techniques for subclinical implant infections may be warranted.