Treatment of severely open tibial fractures, non-unions, and fracture-related infections with a gentamicin-coated tibial nail—clinical outcomes including quality of life analysis and psychological ICD-10-based symptom rating

URN zum Zitieren dieses Dokuments:

urn:nbn:de:bvb:355-epub-517701 Copy

DOI zum Zitieren dieses Dokuments:

10.5283/epub.51770 Copy

Walter, Nike ; Popp, Daniel ; Freigang, Viola ; Nerlich, Michael ; Alt, Volker ; Rupp, Markus

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Lizenz: Creative Commons Namensnennung 4.0 International PDF - Veröffentlichte Version (756kB)

Veröffentlichungsdatum dieses Volltextes: 21 Feb 2022 09:42

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Details

Dokumentenart:	Artikel
Open Access Art:	DEAL (Springer Gold)
Höhe Gebühr (aus OpenAPC):	1894.48
Institution der Zahlung:	Regensburg U
Titel eines Journals oder einer Zeitschrift:	Journal of Orthopaedic Surgery and Research
Verlag:	BMC
Ort der Veröffentlichung:	LONDON
Band:	16
Nummer des Zeitschriftenheftes oder des Kapitels:	1
Seitenbereich:	S. 1-8
Datum:	17 April 2021
Institutionen:	Medizin > Lehrstuhl für Unfallchirurgie Medizin > Abteilung für Psychosomatische Medizin
Sonstige Projekte:	Projekt DEAL
Identifikationsnummer:	Wert Typ 10.1186/s13018-021-02411-8 DOI
Stichwörter / Keywords:	; Antimicrobial-coated nails; Infection prevention; Quality of life
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Ja
Dokumenten-ID:	51770

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Zusammenfassung

BackgroundImplant-associated infections depict a major challenge in orthopedics and trauma surgery putting a high burden on the patients and health care systems, strongly requiring improvement of infection prevention and of clinical outcomes. One strategy includes the usage of antimicrobial-coated implants. We evaluated outcomes after surgical treatment using a gentamicin-coated nail on (i) ...

Zusammenfassung

BackgroundImplant-associated infections depict a major challenge in orthopedics and trauma surgery putting a high burden on the patients and health care systems, strongly requiring improvement of infection prevention and of clinical outcomes. One strategy includes the usage of antimicrobial-coated implants. We evaluated outcomes after surgical treatment using a gentamicin-coated nail on (i) treatment success in terms of bone consolidation, (ii) absence of infection, and (iii) patient-reported quality of life in a patient cohort with high risk of infection/reinfection and treatment failure.MethodsThirteen patients with open tibia fractures (n = 4), non-unions (n = 2), and fracture-related infection (n = 7) treated with a gentamicin-coated intramedullary nail (ETN Protect(TM)) were retrospectively reviewed. Quality of life was evaluated with the EQ-5D, SF-36, and with an ICD-10-based symptom rating (ISR).ResultsAt a mean follow-up of 2.8 years, 11 of the 13 patients (84.6%) achieved bone consolidation without any additional surgical intervention, whereas two patients required a revision surgery due to infection and removal of the implant. No specific implant-related side effects were noted. Quality of life scores were significantly lower compared to a German age-matched reference population. The mean ISR scores revealed mild psychological symptom burden on the scale depression.ConclusionThe use of a gentamicin-coated intramedullary nail seems to be reasonable in open fractures and revision surgery for aseptic non-union or established fracture-related infection to avoid infection complications and to achieve bony union. Despite successful treatment of challenging cases with the gentamicin-treated implant, significantly reduced quality of life after treatment underlines the need of further efforts to improve surgical treatment strategies and psychological support.

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