Treatment of infection following intramedullary nailing of tibial shaft fractures-results of the ORS/ISFR expert group survey. - Archive ouverte HAL
Article Dans Une Revue International Orthopaedics Année : 2019

Treatment of infection following intramedullary nailing of tibial shaft fractures-results of the ORS/ISFR expert group survey.

Résumé

OBJECTIVE: The lack of universally accepted treatment principles and protocols to manage infected intramedullary (IM) nails following tibial fractures continues to challenge us, eliciting a demand for clear guidelines. Our response to this problem was to create an ORS/ISFR taskforce to identify potential solutions and trends based on published evidence and practices globally. MATERIALS AND METHODS: A questionnaire of reported treatment methods was created based on a published meta-analysis on the topic. Treatment methods were divided in two groups: A (retained nail) and B (nail removed). Experts scored the questionnaire items on a scale of 1-4 twice, before and after revealing the success rates for each stage of infection. Inter- and intra-observer variability analysis among experts' personal scores and between experts' scores was performed. An agreement mean and correlation degree between experts' scores was calculated. Finally, a success rate report between groups was performed. RESULTS: Experts underestimated success rate of an individual treatment method compared to published data. The mean difference between experts' scores and published results was + 26.3 ± 46 percentage points. Inter-observer agreement mean was poor (\textless 0.2) for both rounds. Intra-observer agreement mean across different treatment methods showed a wide variability (18.3 to 64.8%). Experts agree more with published results for nail removal on stage 2 and 3 infections. CONCLUSIONS: Experts' and published data strongly agree to retain the implant for stage 1 infections. A more aggressive approach (nail removal) favoured for infection stages 2 and 3. However, literature supports both treatment strategies. EVIDENCE: Clinical Question.
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Dates et versions

hal-03551894 , version 1 (02-02-2022)

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Cyril Mauffrey, David J. Hak, Peter Giannoudis, Volker Alt, Christoph Nau, et al.. Treatment of infection following intramedullary nailing of tibial shaft fractures-results of the ORS/ISFR expert group survey.. International Orthopaedics, 2019, 43 (2), pp.417--423. ⟨10.1007/s00264-018-3964-1⟩. ⟨hal-03551894⟩
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