Management of postoperative infection following open reduction and internal fixation for acetabular fractures / 中华创伤骨科杂志

ABSTRACT

Objective To explore the management of postoperative infection following open reduction and internal fixation for acetabular fractures.Methods Ten patients were treated and completely followed up in Beijing Jishuitan Hospital from February 2012 to December 2016 for postoperative infection after open reduction and internal fixation for acetabular fracture.They were 9 males and one female,aged from 14 to 64 years(mean,40.6 years).According to Letournel classification,there were 2 double-column fractures,2 anterior descending transverse fractures,2 anterior column fractures,one posterior wall fracture,and one posterior wall fracture.Eight cases developed surgical regional infection within 2 weeks after internal fixation,and 2 presented with symptoms of infection more than 3 months after fracture fixation.Vacuum sealing drainage (VSD) was used to treat one case of acute superficial infection;open debridement surgery,carrier with sensitive antibiotics and intravenous antibiotics were used to treat 7 cases of acute deep infection and 2 cases of chronic deep infection.Results The infection symptoms disappeared 9 days after removal of VSD device in the one case of acute superficial infection.Normal fracture union was achieved in 6 cases after their infection was controlled;4 cases had to undergo total hip arthroplasty because their articular structure was damaged after control of infection.The 10 patients were followed up for 6 to 54 months (mean,25.7 months).Their Harris scores at the last follow-up averaged 74.8 (from 32 to 92).Conclusions Negative-pressure wound therapy is an effective management for acute superficial infection after acetabular fracture.Deep acute infection needs early repeated debridement combined with sensitive antibiotic carrier to protect joint function.For infection which is difficult to control or chronic infection associated with structural damage,repeated debridement combined with sensitive antibiotic spacer is effective for infection control at the first stage and artificial total hip arthroplasty can be carried out at the second stage when the infection is controlled.