Table 4.
Methods for detecting open fracture microbial contamination/infection
| Method | References | Details | |
|---|---|---|---|
| Contamination | Surveillance culturing | 50 | Isolation of microbes on artificial media, followed by identification using biochemical and molecular techniques. Surveillance cultures are thought to have little value in predicting infections. |
| DNA sequencing | 23 | The sequencing of taxonomically/phylogenetically informative genes to allow for bacterial community identification. This method is in development and is not used clinically. | |
| qPCR detection | 4,23 | Quantification of microbial load using qPCR of conserved microbial genes. This method is not widely used for clinical prophylaxis of open fractures. | |
| Host protein biomarker identification | 59 | Some host proteins have been identified as potential biomarkers for predicting open fracture healing complications. Many of these proteins have established roles in the immune response, and may be clinically useful upon further investigation. | |
| Infection | Immune-related marker | 65,66 | Identification of host biomarkers, such as secondary rises in C-reactive protein levels, provides good support that a wound or implanted device is infected. |
| Quantitative and qualitative culturing | Culturing of tissue samples can provide insight into what potentially pathogenic microbes are present at a site suspected of being infected, and can be used to predict the most prominent microbes. This can help in the prediction of the infecting organism itself. | ||
| Histopathology | Histopathological examination of tissue sample infiltration by inflammatory cells can provide evidence for infection. | ||
| X-Ray imaging | X-ray evidence of hardware implant nail loosening or widening of the fracture gap both suggest the presence of infection, although this alone is not definitive. | ||
| Nuclear imaging | Nuclear imaging showing a lack of 99mTc accumulation, which indicates dead or devascularized bone, is suggestive of infection. | ||
| Computed tomography | MRI allows for detection of soft tissue abnormalities, but is not effective for areas around metallic implants. PET and PET-CT scanning systems are able to address this deficiency in MRI approaches by allowing for assessment of accumulation of compounds, such as FDG, which indicate potential infection. |
FDG, fluorine 18 fluorodeoxyglucose; MRI, magnetic resonance imaging; PET, positron emission tomography; PET-CT, positron emission tomography-computed tomography; qPCR, quantitative polymerase chain reaction.