Incidence of Fracture-Related Infection Among Adult Trauma Patients Undergoing Operative Fracture Fixation A Prospective Cohort Study at the Orthopaedic and Trauma Surgery Unit, Assiut University Hospital
Fracture-related infection (FRI) is an infection occurring after operative or non-operative management of a fracture, and it represents one of the most serious complications encountered in orthopaedic trauma surgery. In 2018, an international expert group convened by the AO Foundation and the European Bone and Joint Infection Society (EBJIS) published a consensus definition for FRI, establishing standardized confirmatory and suggestive diagnostic criteria to overcome the historical absence of a uniform case definition, which had previously hampered both clinical practice and comparability of research in this field.
- FRI can complicate both open and closed fractures treated by internal or external fixation. Its clinical spectrum ranges from early post-operative wound infection to chronic, recalcitrant post traumatic osteomyelitis, fracture non-union and, in severe cases, amputation of the affected limb.
- The burden of FRI is multidimensional and falls on the patient, the treating surgical team, and the wider community
Reported incidence of FRI varies widely according to fracture type, anatomical site and host/injury-severity factors. Pooled estimates from the literature suggest an overall incidence of approximately 0.4-16% across all operatively treated fractures: closed fractures carry a substantially lower risk (approximately 1-2%) than open fractures, in which incidence commonly exceeds 15% and rises further with increasing severity of soft-tissue and bony injury.
A large multicentre cohort from India applying prospective follow-up reported an overall infection incidence of 2.9% (1.6% in closed and 8.0% in open tibial fractures)
. Risk is further modulated by patient-related factors (diabetes mellitus, smoking, obesity, immunosuppression), injury related factors (high-energy mechanism, soft-tissue compromise, contamination) and treatment related factors (timing of antibiotic prophylaxis and surgical debridement, type of fixation, duration of surgery)
調査の概要
状態
条件
研究の種類
入学 (推定)
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
patient with Open or closed fracture of the appendicular skeleton (long bones, hand, foot, pelvis/acetabulum) requiring operative fixation in the trauma theatre of the unit
説明
Inclusion Criteria:
- Open or closed fracture of the appendicular skeleton (long bones, hand, foot, pelvis/acetabulum) requiring operative fixation in the trauma theatre of the unit
- Surgery performed at the Orthopaedic and Trauma Surgery Unit, Assiut University Hospital, during the study period
- Patient (or legal guardian, where temporary incapacity precludes immediate consent) willing and able to provide informed consent and to participate in scheduled follow-up
Exclusion Criteria:
-
Pathological fractures secondary to malignancy or to metabolic bone disease other than simple osteoporosis (different infection biology and risk profile)
- Periprosthetic fractures, or fractures around a pre-existing implant/prosthesis (risk of misclassification with periprosthetic joint infection, which has its own distinct consensus definition)
- Fractures of the skull, and of the cervical, thoracic or lumbar spine (excluded by precedent in the FRI validation literature, given differing anatomy, infection biology and applicability of the consensus criteria)
- Patients presenting with infection already established at the fracture site prior to, or at the time of, the index surgery at our unit (e.g., late transfer from another facility with a pre existing diagnosis of infection) - excluded to preserve ascertainment of incident (new) rather than prevalent infection
- Fractures managed non-operatively (conservatively)
- Death within 48 hours of surgery from a cause unrelated to infection, precluding any meaningful infection follow-up
- Non-resident patients (e.g., without a reliable local follow-up address) in whom completion of the minimum follow-up period cannot reasonably be assured
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 観測モデル：COHORT
- 時間の展望：PROSPECTIVE
コホートと介入
グループ/コホート |
|---|
|
study group
Adults aged ≥18 years with Open or closed fracture of the appendicular skeleton (long bones, hand, foot, pelvis/acetabulum) requiring operative fixation in the trauma theatre of the unit |
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Incidence of fracture-related infection
時間枠：within 12 months of the index operative fixation
|
Incidence of fracture-related infection, diagnosed using the international FRI consensus criteria in Trauma unit assiut university hospital, expressed as a proportion (%) with 95% confidence interval - overall, and stratified by fracture type (open/closed) and Gustilo-Anderson grade for open fractures. |
within 12 months of the index operative fixation
|
協力者と研究者
スポンサー
研究記録日
主要日程の研究
研究開始 (推定)
一次修了 (推定)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- Incidence Fracture +Infection
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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