Infected nonunion with implant In Situ in long bone fractures, managed by retention of implant-our experience

• Main Authors: S. P S. Gill, Manish Raj, Pulkesh Singh, Dinesh Kumar, Jasveer Singh, Prateek Rastogi
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2017-01-01
• Series: Journal of Orthopedics, Traumatology and Rehabilitation
• Subjects: infected implant; long bone infected implants; postoperative infection; retention of infected implant
• Online Access: http://www.jotr.in/article.asp?issn=0975-7341;year=2017;volume=9;issue=1;spage=29;epage=37;aulast=S.

Introduction: Early Internal fixation of any fracture now days given us great advantage with relation to early mobilization and early returns to daily activity. Rate of infection related to implant surgery reported by numerous study ranges from 0.5% to 4-5% in closed fractures and up to 10% in cases of compound fractures. Post operative infection with implant in place is one of the most difficult conditions to manage. In our study we tried to retain the implants in these cases and evaluated long term result in these cases. Material and Method: We selected total 108 cases of infected implant without union from regular follow cases of operated post operative cases of upper and lower limb long bones managed by nailing and plating 2006 to 2014. Out of 108 cases 94 cases completed their follow up duration. We managed these cases with retention of implant for as long as possible with regular debridement, incision and drainage, pus culture and sensitivity and antibiotics accordingly off and on till attainment of bony union. Final results were evaluated and any implant failure and other revision surgery rates recorded. Results: Out of 94 cases bony union were achieved in 76 cases (81%) with retention of same implant with proper antibiotic coverage, regular follow up and guarded weight bearing. 8 of our cases shows implant failure due to delayed and non union. In 10 cases, removal of implant was required before bony union. Infection related to implant was also cured once implant were removed after attaining bony union without any long term complications. Conclusion: This increase incidence of infection related to implant also aggravated by various drug resistant microorganism. In most of these cases of infected implant, implants can be retained in situ till bony union achieved. Low grade infection with implant didn't have any severe negative consequence on bony union. This infection can be cured with removal of implant once bony union achieved.