Table 1.
Baseline characteristics of the surgery performed
| All cases (n = 421) |
Aseptic cases (n = 305) |
Septic cases (n = 116) |
|
|---|---|---|---|
| Initial indication for surgery (n, %) | |||
| - Fracturea | 333 (79.1) | 238 (78.0) | 95 (81.9) |
| - Arthrodesis | 37 (8.8) | 28 (9.2) | 9 (7.8) |
| - Osteotomy | 33 (7.8) | 26 (8.5) | 7 (6.0) |
| - Tumor surgery | 8 (1.9) | 7 (2.3) | 1 (0.9) |
| - Instability, ligament injury | 5 (1.2) | 3 (1.0) | 2 (1.8) |
| - Other (limb lengthening, war injury) | 5 (1.2) | 3 (1.0) | 2 (1.8) |
| Type of implant (n, %) | |||
| - Plate and/or screws | 325 (77.2) | 239 (78.4) | 86 (74.1) |
| - Intramedullary nail | 71 (16.9) | 52 (17.0) | 19 (16.4) |
| - K-wires / Elastic nails / tension band | 21 (5.0) | 12 (3.9) | 9 (7.8) |
| - Other (staple, anchor) | 4 (1.0) | 2 (0.6) | 2 (1.8) |
| Indication for removal of internal fixation (n, %) | |||
| - Infection suspected | 105 (24.9) | 28 (9.2) | 77 (66.3) |
| ○ Chronic infectionb | 72 (17.1) | 22 (7.2) | 50 (43.1) |
| ○ Acute / haematogenous infection | 33 (7.9) | 6 (2.0) | 27 (23.3) |
| - Infection not suspected | 316 (75.1) | 277 (90.8) | 39 (33.6) |
| ○ Nonunionc | 84 (20.0) | 74 (24.3) | 10 (8.6) |
| ○ Malposition, loss of fixation | 57 (13.5) | 48 (15.7) | 9 (7.7) |
| ○ Symptomatic hardware | 57 (13.5) | 52 (17.0) | 5 (4.3) |
| ○ Osteoarthritis | 31 (7.4) | 27 (8.9) | 4 (3.4) |
| ○ Avascular necrosis | 24 (5.7) | 20 (6.6) | 4 (3.4) |
| ○ Cutout | 10 (2.4) | 9 (3.0) | 1 (0.9) |
| ○ Periimplant fracture | 19 (4.5) | 18 (5.9) | 1 (0.9) |
| ○ Hardware breakage | 14 (3.3) | 14 (4.6) | 0 (0.0) |
| ○ Joint stiffness | 9 (2.1) | 7 (2.3) | 2 (1.7) |
| ○ Planned removal | 7 (1.7) | 6 (2.0) | 1 (0.9) |
| ○ Other (Charcot, tumor progression) | 4 (1.0) | 2 (0.7) | 2 (1.8) |
| Anatomical location, AO region (n, %) | |||
| - 1: Humerus, clavicle, scapula | 81 (19.2) | 54 (17.7) | 27 (23.3) |
| - 2: Radius, ulna | 41 (9.7) | 31 (10.2) | 10 (8.6) |
| - 3: Femur, patella | 121 (28,7) | 101 (33.1) | 20 (17.2) |
| - 4: Tibia, fibula | 130 (30.9) | 88 (28.9) | 42 (36.2) |
| - 6: Pelvis, acetabulum | 9 (2.1) | 5 (1.6) | 4 (3.5) |
| - 7: Hand | 1 (0.2) | 0 (0.0) | 1 (0.9) |
| - 8: Foot | 38 (9.0) | 26 (8.5) | 12 (10.3) |
| Surgery performed (n, %) | |||
| - Implant removal | 185 (43.9) | 109 (35.7) | 76 (65.5) |
| - Reosteosynthesis | 156 (37.1) | 131 (43.0) | 25 (21.6) |
| - Arthroplasty | 51 (12.1) | 46 (15.1) | 5 (4.3) |
| - Masquelet, joint spacer | 14 (3.3) | 9 (3.0) | 5 (4.3) |
| - External fixation for nonunion | 6 (1.4) | 2 (0.7) | 4 (3.4) |
| - Dynamisation | 4 (1.0) | 4 (1.3) | 0 (0.0) |
| - Arthrodesis | 3 (0.7) | 3 (1.0) | 0 (0.0) |
| - Amputation | 1 (0.2) | 0 (0.0) | 1 (0.9) |
| - Ligament reconstruction | 1 (0.2) | 1 (0.3) | 0 (0.0) |
| Diagnosis of infection (n, %) | |||
| - No infection | 279 (66.3) | 279 (91.5) | 0 (0.0) |
| - Confirmed infection | 116 (27.6) | 0 (0.0) | 116 (100.0) |
| - Suggestive infection | 26 (6.2) | 26 (8.5) | 0 (0.0) |
| Radiographic changes (n, %) | |||
| - Radiolucent line | 48 (11.4) | 29 (9.5) | 19 (16.4) |
| - Implant breakage | 52 (12.4) | 43 (14.1) | 9 (7.8) |
| - Implant displacement | 45 (10.7) | 32 (10.5) | 13 (11.2) |
| - Periosteal reaction | 30 (7.1) | 16 (5.2) | 14 (12.1) |
| - None | 298 (70.8) | 218 (71.5) | 80 (69.0) |
Note. Data are indicated as no. of cases (%)
a Of the 333 fracture cases, 34 were open fractures (8.4% of the total series)
b Chronic infection included non-unions in which infection was suspected
c Non-unions without any suspicion of infection, ascertained by the medical history, clinical examination and tests