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Fractures: Bone Repair

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High-Resolution Three-Dimensional Imaging of the Footpad Vasculature in a Murine Hindlimb Gangrene Model

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Lower Extremity Amputation in Fracture-Related Infection.

Karen J Carter¹, Matthew T Yeager, Robert W Rutz

¹Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.

Journal of Orthopaedic Trauma

|August 16, 2024

Summary

Chronic kidney disease (CKD) significantly increases the risk of amputation in patients with fracture-related infections (FRIs). Methicillin-resistant Staphylococcus aureus (MRSA) was also identified as a key factor in amputation cases involving Staphylococcus.

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Area of Science:

Orthopedic Surgery
Infectious Diseases
Trauma Care

Background:

Fracture-related infections (FRIs) are serious complications following bone fractures.
Amputation is a severe outcome for patients with FRIs, necessitating identification of risk factors.

Purpose of the Study:

To identify risk factors associated with amputation in patients suffering from lower extremity (femur and tibia) FRIs.
To analyze the impact of demographics, comorbidities, and infection characteristics on amputation rates.

Main Methods:

Retrospective cohort study conducted at a Level I Trauma Center from 2013-2020.
Analysis of 196 adult patients with operatively managed femur or tibia fractures and documented FRIs.
Evaluation of risk factors including demographics, comorbidities, injury patterns, and microbiological data.

Main Results:

The overall amputation rate was 9.2%.
Chronic kidney disease (CKD) was a significant risk factor, with patients being 28.8 times more likely to undergo amputation (aOR = 28.8).
Methicillin-resistant Staphylococcus aureus (MRSA) infections were present in all amputation cases involving Staphylococcus and were associated with higher amputation rates compared to methicillin-sensitive Staphylococcus aureus.

Conclusions:

CKD is a critical risk factor for amputation in patients with femur and tibia FRIs.
MRSA is a significant pathogen in cases requiring amputation for Staphylococcus-related FRIs.
Identifying high-risk patients and infection patterns can aid surgeons in preventing amputations and reducing patient burden.