Tyler E Warkentien1, Louis R Lewandowski2, Benjamin K Potter2, Joseph L Petfield3, Daniel J Stinner3, Margot Krauss4, Clinton K Murray4, David R Tribble5. 1. Infectious Disease, Walter Reed National Military Medical Center, Bethesda, MD. Dr. Warkentien is now with the Naval Medical Center Portsmouth, VA. 2. Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Lewandowski is now with the Naval Medical Center Camp Lejeune, Jacksonville, NC. 3. Brooke Army Medical Center, JBSA Fort Sam Houston, TX. 4. Westat, Rockville, MD. 5. Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.
Abstract
OBJECTIVE: To determine risk factors for osteomyelitis in US military personnel with combat-related, extremity long bone (humerus, radius, and ulna) open fractures. DESIGN: Retrospective observational case-control study. SETTING: US military regional hospital in Germany and tertiary care military hospitals in the United States (2003-2009). PATIENTS/PARTICIPANTS: Sixty-four patients with open upper extremity fractures who met diagnostic osteomyelitis criteria (medical record review verification) were classified as cases. Ninety-six patients with open upper extremity fractures who did not meet osteomyelitis diagnostic criteria were included as controls. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENTS: Multivariable odds ratios (ORs; 95% confidence interval [CI]). RESULTS: Among patients with surgical implants, osteomyelitis cases had longer time to definitive orthopaedic surgery compared with controls (median: 26 vs. 11 days; P < 0.001); however, there was no significant difference with timing of radiographic union. Being injured between 2003 and 2006, use of antibiotic beads, Gustilo-Anderson [GA] fracture classification (highest with GA-IIIb: [OR: 22.20; CI: 3.60-136.95]), and Orthopaedic Trauma Association Open Fracture Classification skin variable (highest with extensive degloving [OR: 15.61; CI: 3.25-74.86]) were independently associated with osteomyelitis risk. Initial stabilization occurring outside of the combat zone was associated with reduced risk of osteomyelitis. CONCLUSIONS: Open upper extremity fractures with severe soft-tissue damage have the highest risk of developing osteomyelitis. The associations with injuries sustained 2003-2006 and location of initial stabilization are likely from evolving trauma system recommendations and practice patterns during the timeframe. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVE: To determine risk factors for osteomyelitis in US military personnel with combat-related, extremity long bone (humerus, radius, and ulna) open fractures. DESIGN: Retrospective observational case-control study. SETTING: US military regional hospital in Germany and tertiary care military hospitals in the United States (2003-2009). PATIENTS/PARTICIPANTS: Sixty-four patients with open upper extremity fractures who met diagnostic osteomyelitis criteria (medical record review verification) were classified as cases. Ninety-six patients with open upper extremity fractures who did not meet osteomyelitis diagnostic criteria were included as controls. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENTS: Multivariable odds ratios (ORs; 95% confidence interval [CI]). RESULTS: Among patients with surgical implants, osteomyelitis cases had longer time to definitive orthopaedic surgery compared with controls (median: 26 vs. 11 days; P < 0.001); however, there was no significant difference with timing of radiographic union. Being injured between 2003 and 2006, use of antibiotic beads, Gustilo-Anderson [GA] fracture classification (highest with GA-IIIb: [OR: 22.20; CI: 3.60-136.95]), and Orthopaedic Trauma Association Open Fracture Classification skin variable (highest with extensive degloving [OR: 15.61; CI: 3.25-74.86]) were independently associated with osteomyelitis risk. Initial stabilization occurring outside of the combat zone was associated with reduced risk of osteomyelitis. CONCLUSIONS:Open upper extremity fractures with severe soft-tissue damage have the highest risk of developing osteomyelitis. The associations with injuries sustained 2003-2006 and location of initial stabilization are likely from evolving trauma system recommendations and practice patterns during the timeframe. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Authors: Matthew A Napierala; Jessica C Rivera; Travis C Burns; Clinton K Murray; Joseph C Wenke; Joseph R Hsu Journal: J Trauma Acute Care Surg Date: 2014-09 Impact factor: 3.313
Authors: Paul H Yi; Alexander A Weening; Sangmin R Shin; Khalil I Hussein; Paul Tornetta; Andrew Jawa Journal: Clin Orthop Relat Res Date: 2014-07 Impact factor: 4.176
Authors: Michael B Gottschalk; William Carpenter; Elise Hiza; William Reisman; James Roberson Journal: J Bone Joint Surg Am Date: 2016-09-07 Impact factor: 5.284
Authors: William D Lack; Madhav A Karunakar; Marc R Angerame; Rachel B Seymour; Stephen Sims; James F Kellam; Michael J Bosse Journal: J Orthop Trauma Date: 2015-01 Impact factor: 2.512
Authors: Kirsten Kortram; Hans Bezstarosti; Willem-Jan Metsemakers; Michael J Raschke; Esther M M Van Lieshout; Michael H J Verhofstad Journal: Int Orthop Date: 2017-07-25 Impact factor: 3.075
Authors: Joseph Westgeest; Donald Weber; Sukhdeep K Dulai; Joseph W Bergman; Richard Buckley; Lauren A Beaupre Journal: J Orthop Trauma Date: 2016-03 Impact factor: 2.512
Authors: Joseph L Petfield; Louis R Lewandowski; Laveta Stewart; Clinton K Murray; David R Tribble Journal: Mil Med Date: 2022-05-04 Impact factor: 1.563
Authors: Cheng Li; Andrew L Foster; Nicholas Hang Bao Han; Andrej Trampuz; Michael Schuetz Journal: Biomed Res Int Date: 2022-04-14 Impact factor: 3.246