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. 2021 Mar 22:14:995-1005.
doi: 10.2147/JIR.S297329. eCollection 2021.

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

Michael C Tanner  1 , Raban Arved Heller  1   2   3 , Andreas Grimm  1 , Stefan Zimmermann  4 , Maximilian Pilz  5 , Louisa Jurytko  1 , Matthias Miska  1 , Lars Helbig  1 , Gerhard Schmidmaier  1 , Patrick Haubruck  1   6
Affiliations

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

Michael C Tanner et al. J Inflamm Res. .

Abstract

Background: Occult infections (OI) lack typical inflammatory signs, making them challenging to diagnose. Uncertainty remains regarding OI's influence on the outcome of autologous bone grafting (ABG), and evidence-based recommendations regarding an appropriate course of action are missing. Thus, we sought to determine the incidence of an OI in patients receiving ABG, evaluate whether it influences the outcome of ABG and whether associated risk factors have a further negative influence.

Methods: This study was designed as a large size single-center case-control study investigating patients treated between 01/01/2010 and 31/12/2016 with a minimum follow-up of 12 months. Patients ≥18 years presenting with a recalcitrant non-union of the lower limb receiving surgical bone reconstruction, including bone grafting, were included. A total of 625 patients were recruited, and 509 patients included in the current study. All patients received surgical non-union therapy based on the "diamond concept" including bone reconstruction using ABG. Additionally, multiple tissue samples were harvested and microbiologically analyzed. Tissue samples were microbiologically evaluated regarding an OI. Bone healing was analyzed using clinical and radiological parameters, patient characteristics and comorbidities investigated and ultimately results correlated.

Results: Forty-six out of 509 cases with OI resulted in an incidence of 9.04%. Overall consolidation time was increased by 15.08 weeks and radiological outcome slightly impaired (79.38% vs 71.42%), differences were at a non-significant extent. 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.

Conclusion: Surgeons treating recalcitrant non-unions should be aware that an OI is common. If an OI is diagnosed subsequent to ABG the majority of patients does not need immediate revision surgery. However, special attention needs to be paid to high-risk patients.

Keywords: bone healing; bone infection; bone regeneration; infection; non-union.

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Conflict of interest statement

Mr Raban Arved Heller reports grants from Oskar-Helene-Heim foundation, Berlin, during the conduct of the study. The authors declare no other conflicts of interest.

Figures

Figure 1
Figure 1
The patient allocation and inclusion process into individual analyses is visualized.
Figure 2
Figure 2
(A) shows the healing and outcome of patients suffering from an OI (study) and patients without OI (control). Duration is shown in years, while outcome is shown as percentages (here 1 equals 100%). (B) visualizes the predictive performance of different computational models that were compared. While 1 shows the final model included into our study, 2 and 3 depict the performance of models including merely one variable.
Figure 3
Figure 3
(A) shows the individual pathogens found during microbiological analysis of intraoperative tissue samples for responder (consolidation) and non-responder (no consolidation) of treatment. (B) Pathogens were summarized into coherent groups of bacteria by an experienced microbiologist.
See this image and copyright information in PMC

References

    1. Mills LA, Aitken SA, Simpson A. The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults. Acta Orthop. 2017;88(4):434–439. doi:10.1080/17453674.2017.1321351 - DOI - PMC - PubMed
    1. Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ 3rd. Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res. 2014;29(3):581–589. doi:10.1002/jbmr.2072 - DOI - PMC - PubMed
    1. Giannoudis PV, Harwood PJ, Tosounidis T, Kanakaris NK. Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes. Injury. 2016;47(Suppl 6):S53–S61. doi:10.1016/S0020-1383(16)30840-3 - DOI - PubMed
    1. Helbig L, Bechberger M, Aldeeri R, et al. Initial peri- and postoperative antibiotic treatment of infected nonunions: results from 212 consecutive patients after mean follow-up of 34 months. Ther Clin Risk Manag. 2018;14:59–67. doi:10.2147/TCRM.S152008 - DOI - PMC - PubMed
    1. Moghaddam A, Thaler B, Bruckner T, Tanner M, Schmidmaier G. Treatment of atrophic femoral non-unions according to the diamond concept: results of one- and two-step surgical procedure. J Orthop. 2017;14(1):123–133. doi:10.1016/j.jor.2016.10.003 - DOI - PMC - PubMed

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