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Time-dependent microbial colonisation of temporary external fixations: a prospective descriptive study.

Thomas Kusnik1, Ole Somberg2, Thomas Rosteius2

  • 1Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Hospital of the Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany. thomas.kusnik@edu.ruhr-uni-bochum.de.

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Prolonged external fixation increases microbial colonization risk on fracture treatment screws. Longer fixation times elevate the likelihood of bacterial presence on Schanz screws, impacting patient outcomes.

Keywords:
External fixation colonisation risk factors ASA score sonication

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Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Biomedical Engineering

Background:

  • External fixators are crucial for temporary fracture stabilization when immediate definitive treatment is not feasible.
  • The impact of external fixator duration on screw colonization before internal fixation remains under-investigated.

Purpose of the Study:

  • To investigate the relationship between external fixation duration and microbial colonization of Schanz screws.
  • To identify patient-related factors influencing screw colonization.

Main Methods:

  • Prospective study of 271 adult patients undergoing external fixation.
  • Sonication of Schanz screw tips removed during definitive osteosynthesis to detect microbial colonization.
  • Analysis of fixation time, patient factors, and microbial spectrum.

Main Results:

  • A 32.5% rate of positive microbial colonization was observed.
  • Fixation times exceeding 8 days significantly increased colonization rates (43.3% vs. 23.8%).
  • Each additional day of fixation correlated with increased colonization odds; ASA score ≥ 3 was an independent risk factor.

Conclusions:

  • External fixation duration is a significant, time-dependent risk factor for Schanz screw colonization.
  • Extended fixation periods necessitate careful consideration due to increased infection risk.
  • Higher ASA scores are independently associated with a greater probability of microbial colonization.