The Influence of an Occult Infection on the Outcome of Autologous Bone Grafting During Surgical Bone Reconstruction: A Large Single-Center Case-Control Study

Journal of Inflammation Research, 2021 · DOI: http://doi.org/10.2147/JIR.S297329 · Published: January 1, 2021

Immunology Orthopedics Musculoskeletal Medicine

Simple Explanation

Long-bone fractures that do not heal in a timely manner pose a challenge. Bone material from the patient is effective for treating these non-unions. Local infections are a risk factor to the success of this treatment. Occult infections are commonly diagnosed after bone grafting with the use of intraoperative tissue cultures unsettling surgeons. It is unclear if these occult infections affect the outcome of treatment and how common they are. This study provides data that shows that while occult infections are frequent the majority of patients don't need immediate revision surgery. However, surgeons should pay special attention to high-risk patients.

Study Duration

6 Years

Participants

509 patients

Evidence Level

Case-control study

Key Findings

1
The incidence of occult infections after non-union treatment of the lower limb remains at 9.04% despite thorough preoperative screening.
2
Overall consolidation time was increased by 15.08 weeks in cases with occult infection, and radiological outcome was slightly impaired (79.38% vs 71.42%), though these differences were not statistically significant.
3
Diabetes mellitus had a significant negative influence on consolidation time (p=0.0313), while age (p=0.0339), smoking status (p=0.0337), diabetes mellitus (p=0.0400) and increased BMI (p=0.0315) showed a significant negative influence on the outcome of bone grafting.

Research Summary

This study aimed to determine the incidence of occult infections (OI) in patients receiving autologous bone grafting (ABG) for non-union (NU) treatment, evaluate its impact on the outcome, and identify associated risk factors. The study found a 9.04% incidence of OI despite preoperative screening, with a non-significant increase in consolidation time and impairment of radiological outcome in patients with OI. The research also identified diabetes mellitus, age, smoking, and BMI as significant risk factors negatively influencing the outcome of bone grafting, suggesting the need for special attention to high-risk patients.

Practical Implications

Infection Awareness

Surgeons should be aware of the potential for occult infections even with negative pre-operative results.

Patient Monitoring

Meticulous follow-up is crucial to detect non-responders early.

Risk Factor Management

Mitigate risk factors like smoking and diabetes prior to NU treatment.

Study Limitations

1
Reduced number of patients due to strict inclusion/exclusion criteria and small number of patients showing OI.
2
Off-site follow-up care frequently reducing the follow-up in our hospital.
3
Full fungal culture is missing.

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