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No increased risk of acute osteomyelitis associated with closed or open long bone shaft fracture
Areg Grigorian1, Sebastian Schubl1, John Scolaro2
1University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
Objectives:
Osteomyelitis of the long bones can result from hematogenous spread, direct inoculation or from a contiguous focus of infection. The association of osteomyelitis after long bone fractures has widely been believed to be true by practicing surgeons since the 1950s, even though the evidence has been poor. We hypothesized that long bone shaft fracture and major bone surgery are independent risk factors for osteomyelitis in adult trauma patients.
Methods:
The National Trauma Data Bank (NTDB) was queried between 2007 and 2015 for patients ≥18 years of age presenting after trauma. Patients with long bone shaft fractures (femur, tibia/fibula, humerus) were identified and rate of acute osteomyelitis was calculated. Univariable logistic regression was performed. A multivariable logistic regression was performed to identify risk factors for development of acute osteomyelitis.
Results:
From 5,494,609 patients, 358,406 were identified to have long bone shaft fractures (6.5%) with the majority being tibia/fibula (44.3%). The osteomyelitis rate in long bone shaft fractures was 0.05%. Independent risk factors for osteomyelitis included major humerus surgery and major tibia/fibula surgery. The strongest risk factor was non-pseudomonas bacteremia. Long bone shaft fractures were not found to be an independent risk factor for osteomyelitis (p > 0.05).
Conclusions:
Long bone shaft fractures are not independently associated with increased risk for osteomyelitis. Major extremity surgery on the humerus and tibia/fibula, but not femur, are independent risk factors for osteomyelitis. However, the strongest risk factor is non-pseudomonas bacteremia.
Insights
Long bone shaft fractures do not independently increase osteomyelitis risk. Major humerus and tibia/fibula surgery are risk factors, but non-pseudomonas bacteremia is the strongest predictor of osteomyelitis in trauma patients.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Trauma Research
Background:
- Osteomyelitis following long bone fractures is a common concern for surgeons.
- Previous evidence linking long bone shaft fractures to osteomyelitis has been limited.
- This study investigates the independent risk of fractures versus surgery for osteomyelitis.
Purpose of the Study:
- To determine if long bone shaft fractures are independent risk factors for osteomyelitis.
- To identify independent risk factors for acute osteomyelitis in adult trauma patients.
- To compare the risk of fracture versus major surgery in developing osteomyelitis.
Main Methods:
- Analysis of the National Trauma Data Bank (NTDB) from 2007-2015.
- Inclusion of adult patients (≥18 years) with long bone shaft fractures (femur, tibia/fibula, humerus).
- Logistic regression models (univariable and multivariable) to identify risk factors for osteomyelitis.
Main Results:
- Osteomyelitis rate in long bone shaft fractures was 0.05%.
- Major humerus and tibia/fibula surgery were identified as independent risk factors.
- Non-pseudomonas bacteremia was the strongest predictor of osteomyelitis; long bone shaft fractures were not independent risk factors (p > 0.05).
Conclusions:
- Long bone shaft fractures are not independently associated with an increased risk of osteomyelitis.
- Major extremity surgery (humerus, tibia/fibula) increases osteomyelitis risk, but femur surgery does not.
- Non-pseudomonas bacteremia is the most significant risk factor for osteomyelitis in this trauma cohort.
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