W J Metsemakers1, K Kortram2, M Morgenstern3, T F Moriarty4, I Meex5, R Kuehl6, S Nijs5, R G Richards4, M Raschke7, O Borens8, S L Kates9, C Zalavras10, P V Giannoudis11, M H J Verhofstad2. 1. Department of Trauma Surgery, University Hospitals Leuven, Belgium. Electronic address: willem-jan.metsemakers@uzleuven.be. 2. Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. 3. Department of Orthopaedic and Trauma Surgery, University Hospital of Basel, Switzerland. 4. AO Research Institute Davos, Switzerland. 5. Department of Trauma Surgery, University Hospitals Leuven, Belgium. 6. Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland. 7. Department of Orthopaedic and Trauma Surgery, University Hospital of Münster, Germany. 8. Orthopedic Septic Surgical Unit, Department of the Locomotor Apparatus and Department of Surgery and Anaesthesiology, Lausanne University Hospital, Lausanne, Switzerland. 9. Department of Orthopaedic Surgery, Virginia Commonwealth University, USA. 10. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA. 11. Department of Trauma and Orthopaedic Surgery, University Hospital of Leeds, United Kingdom and NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
Abstract
INTRODUCTION: One of the most challenging musculoskeletal complications in modern trauma surgery is infection after fracture fixation (IAFF). Although infections are clinically obvious in many cases, a clear definition of the term IAFF is crucial, not only for the evaluation of published research data but also for the establishment of uniform treatment concepts. The aim of this systematic review was to identify the definitions used in the scientific literature to describe infectious complications after internal fixation of fractures. The hypothesis of this study was that the majority of fracture-related literature do not define IAFF. MATERIAL AND METHODS: A comprehensive search was performed in Embase, Cochrane, Google Scholar, Medline (OvidSP), PubMed publisher and Web-of-Science for randomized controlled trials (RCTs) on fracture fixation. Data were collected on the definition of infectious complications after fracture fixation used in each study. Study selection was accomplished through two phases. During the first phase, titles and abstracts were reviewed for relevance, and the full texts of relevant articles were obtained. During the second phase, full-text articles were reviewed. All definitions were literally extracted and collected in a database. Then, a classification was designed to rate the quality of the description of IAFF. RESULTS: A total of 100 RCT's were identified in the search. Of 100 studies, only two (2%) cited a validated definition to describe IAFF. In 28 (28%) RCTs, the authors used a self-designed definition. In the other 70 RCTs, (70%) there was no description of a definition in the Methods section, although all of the articles described infections as an outcome parameter in the Results section. CONCLUSION: This systematic review shows that IAFF is not defined in a large majority of the fracture-related literature. To our knowledge, this is the first study conducted with the objective to explore this important issue. The lack of a consensus definition remains a problem in current orthopedic trauma research and treatment and this void should be addressed in the near future.
INTRODUCTION: One of the most challenging musculoskeletal complications in modern trauma surgery is infection after fracture fixation (IAFF). Although infections are clinically obvious in many cases, a clear definition of the term IAFF is crucial, not only for the evaluation of published research data but also for the establishment of uniform treatment concepts. The aim of this systematic review was to identify the definitions used in the scientific literature to describe infectious complications after internal fixation of fractures. The hypothesis of this study was that the majority of fracture-related literature do not define IAFF. MATERIAL AND METHODS: A comprehensive search was performed in Embase, Cochrane, Google Scholar, Medline (OvidSP), PubMed publisher and Web-of-Science for randomized controlled trials (RCTs) on fracture fixation. Data were collected on the definition of infectious complications after fracture fixation used in each study. Study selection was accomplished through two phases. During the first phase, titles and abstracts were reviewed for relevance, and the full texts of relevant articles were obtained. During the second phase, full-text articles were reviewed. All definitions were literally extracted and collected in a database. Then, a classification was designed to rate the quality of the description of IAFF. RESULTS: A total of 100 RCT's were identified in the search. Of 100 studies, only two (2%) cited a validated definition to describe IAFF. In 28 (28%) RCTs, the authors used a self-designed definition. In the other 70 RCTs, (70%) there was no description of a definition in the Methods section, although all of the articles described infections as an outcome parameter in the Results section. CONCLUSION: This systematic review shows that IAFF is not defined in a large majority of the fracture-related literature. To our knowledge, this is the first study conducted with the objective to explore this important issue. The lack of a consensus definition remains a problem in current orthopedic trauma research and treatment and this void should be addressed in the near future.
Authors: M Morgenstern; A Vallejo; M A McNally; T F Moriarty; J Y Ferguson; S Nijs; W J Metsemakers Journal: Bone Joint Res Date: 2018-08-04 Impact factor: 5.853
Authors: H Bezstarosti; E M M Van Lieshout; L W Voskamp; K Kortram; W Obremskey; M A McNally; W J Metsemakers; M H J Verhofstad Journal: Arch Orthop Trauma Surg Date: 2018-10-20 Impact factor: 3.067
Authors: Justin V C Lemans; Monique G G Hobbelink; Frank F A IJpma; Joost D J Plate; Janna van den Kieboom; Paul Bosch; Luke P H Leenen; Moyo C Kruyt; Andor W J M Glaudemans; Geertje A M Govaert Journal: Eur J Nucl Med Mol Imaging Date: 2018-12-07 Impact factor: 9.236
Authors: Geertje A M Govaert; Richard Kuehl; Bridget L Atkins; Andrej Trampuz; Mario Morgenstern; William T Obremskey; Michael H J Verhofstad; Martin A McNally; Willem-Jan Metsemakers Journal: J Orthop Trauma Date: 2020-01 Impact factor: 2.884
Authors: Carlos Prada; Stephanie L Tanner; Francesc A Marcano-Fernández; Sofia Bzovsky; Emil H Schemitsch; Kyle Jeray; Brad Petrisor; Mohit Bhandari; Sheila Sprague Journal: Clin Orthop Relat Res Date: 2020-12 Impact factor: 4.755
Authors: Luciana Souza Jorge; Patrícia Silva Fucuta; Maria Gabriele L Oliveira; Marcelo Arruda Nakazone; Juliana Arruda de Matos; Alceu Gomes Chueire; Mauro José Costa Salles Journal: J Bone Jt Infect Date: 2018-02-20