Title : Osteosynthesis implant infections: A series of 5 cases
Abstract:
Despite some major advancements in surgery and advances in an2bio2c prophylaxis, orthopedic implant infec2ons remain a large concern, with reported rates of 0.5% to 2% in closed fractures and even more than 30% for open fractures. The true prevalence is likely underappreciated because of diagnos2c hurdles. This is a report of pa2ents treated in our surgical intensive care unit for two months. We assessed five young polytrauma2zed pa2ents (22 to 36 years; four men, one woman) with early-onset postopera2ve infec2ons involving osteosynthesis. Clinical, biological, microbiological, radiological, and therapeu2c details were retrieved from medical records. Microbiological cultures demonstrated polymicrobial infec2ons with Staphylococcus aureus as well as mul2drug-resistant Gram-nega2ve bacilli. Three pa2ents had disastrous outcomes, including two cases of dying from infec2ons and one with amputa2on of a limb; the other two had a favorable clinical course. These findings underscore the persis2ng severity of infec2ons associated with implant placement in young, severely injured pa2ents. Mul2drug-resistant organisms and biofilm forma2on are highly prevalent and create many difficul2es for conven2onal therapies that require early diagnosis and personalized surgical interven2ons. Moreover, treatment of these infec2ons will need a personalized approach guided by an adap2ve and personalized treatment approach that will guide modern molecular diagnos2cs and mul2disciplinary care protocols; this will ensure full clinical effec2veness. This example series highlights an underrepresented issue and lethal danger of orthopedic implant infec2ons, regardless of the best surgical or prophylac2c environment. It focuses on surveillance and intense early interven2on, ongoing surveillance, intense early treatment, and the quest for new solu2ons to counteract the forma2on of resistant biofilms. All in all, implant infec2ons are a serious underlying complica2on that will go largely unno2ced. They must be treated by keeping a^en2on and care personalized so as not to have catastrophic consequences for their devasta2ng func2onal or even fatal ramifica2ons.
