Outcomes of Aseptic, Septic, and Occult Infected Index Nonunion Repair: A Retrospective Comparative Study

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Trauma Surgery

Background:

• Nonunion fractures present a significant challenge in orthopedic surgery.
• Fracture-related infection (FRI) criteria help classify nonunions into septic, aseptic, and occult infected categories.
• Understanding the effectiveness of surgical intervention for different nonunion types is crucial for patient outcomes.

Purpose of the Study:

• To compare the effectiveness of index nonunion surgery across three distinct patient groups: septic nonunions (SP), aseptic nonunions (AP), and occult infected nonunions (OP).
• To evaluate surgical success rates and postoperative infection rates based on FRI criteria classification.

Main Methods:

• Retrospective review of skeletally mature patients with nonunions and inflammatory labs over a 10-year period.
• Classification of patients into SP, AP (culture-negative aseptic), and OP (culture-positive aseptic) groups using FRI criteria.
• Primary outcome: successful union after index surgery without reoperation.

Main Results:

• A total of 208 patients were analyzed (OP: 29, AP: 125, SP: 54).
• Occult infected patients demonstrated the highest successful union rate (79.3%), followed by aseptic (72.8%) and septic patients (50.0%).
• Postoperative infection rates were significantly lower in OP (10.3%) and AP (16.0%) compared to SP (35.2%).

Conclusions:

• Index nonunion surgery outcomes are significantly worse in septic patients compared to aseptic and occult infected patients.
• The success of surgery for occult infected nonunions is comparable to aseptic cases.
• Subclinical fracture-related infection does not appear to significantly compromise surgical outcomes.