Late infection in healed fractures after open reduction and internal fixation

Nine patients with normal fracture healing after open reduction and internal fixation presented with late infection 15 months to 19 years after injury. Eight of the nine patients had a history of pain at the fracture site for 3 weeks or longer. Elevated temperature and white blood cell count were unreliable indicators of infection. Six patients had an elevated erythrocyte sedimentation rate that correlated with osteomyelitis. Roentgenograms showed resorption around the implant in seven patients and a small nidus in two patients. There was a change in position of fixation screws in four patients. Cigarette smoking and alcoholism were the most common systemic risk factors. Local risk factors were open fracture, lower-extremity site, distal femur site, and chronic edema of the lower extremities. Late infection should be included in the differential diagnosis of patients presenting with new-onset pain and a retained orthopaedic implant. Patients who fall into this group may be at increased risk for development of late hematogenous infection of orthopaedic implants.