The value of conventional radiographs for diagnosing internal fixation-associated infection.
Conventional radiography
Diagnostic imaging
Internal fixation
Prosthesis-related infections
Radiography
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
04 May 2021
04 May 2021
Historique:
received:
12
10
2020
accepted:
10
03
2021
entrez:
5
5
2021
pubmed:
6
5
2021
medline:
15
5
2021
Statut:
epublish
Résumé
The aim of the study is to assess the diagnostic value of preoperative conventional radiographs for diagnosing infection associated with internal fixation devices. We prospectively collected data of patients undergoing removal of internal fixation devices for any reason. Infection was diagnosed in case of purulence, sinus tract, positive histopathology and/or positive peri-implant tissue or sonication fluid culture. In radiographs radiolucent lines, implant breakage or displacement, or periosteal reaction were assessed. White blood cell count (WBC) and serum C-reactive protein (CRP) were determined at admission. We included 421 surgeries in 380 patients (median age 53.6 years, range 11-98 years), mainly indicated for infection (24.9%), nonunion (20.0%) and symptomatic implants (13.5%). Radiologic signs of infection included radiolucent lines (11.4%); implant breakage (12.4%) or displacement (10.7%); and periosteal reaction (7.1%). Infection was confirmed in 116 cases (27.6%). Only radiolucent lines (OR = 1.86 [95%CI: 1.00-3.38]) and periosteal reaction (OR = 2.48 [95%CI: 1.17-5.26]) were associated with infection, with a low sensitivity (16.4 and 12.1%, respectively), and high specificity (90.5 and 94.8%, respectively). Preoperative WBC and CRP had a sensitivity of 23.0 and 35.3%, and specificity of 91.7 and 89.5%, respectively. Radiological signs suggestive of infection were uncommon. Radiolucency and periosteal reaction were associated with infection, though with low sensitivity.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of the study is to assess the diagnostic value of preoperative conventional radiographs for diagnosing infection associated with internal fixation devices.
METHODS
METHODS
We prospectively collected data of patients undergoing removal of internal fixation devices for any reason. Infection was diagnosed in case of purulence, sinus tract, positive histopathology and/or positive peri-implant tissue or sonication fluid culture. In radiographs radiolucent lines, implant breakage or displacement, or periosteal reaction were assessed. White blood cell count (WBC) and serum C-reactive protein (CRP) were determined at admission.
RESULTS
RESULTS
We included 421 surgeries in 380 patients (median age 53.6 years, range 11-98 years), mainly indicated for infection (24.9%), nonunion (20.0%) and symptomatic implants (13.5%). Radiologic signs of infection included radiolucent lines (11.4%); implant breakage (12.4%) or displacement (10.7%); and periosteal reaction (7.1%). Infection was confirmed in 116 cases (27.6%). Only radiolucent lines (OR = 1.86 [95%CI: 1.00-3.38]) and periosteal reaction (OR = 2.48 [95%CI: 1.17-5.26]) were associated with infection, with a low sensitivity (16.4 and 12.1%, respectively), and high specificity (90.5 and 94.8%, respectively). Preoperative WBC and CRP had a sensitivity of 23.0 and 35.3%, and specificity of 91.7 and 89.5%, respectively.
CONCLUSIONS
CONCLUSIONS
Radiological signs suggestive of infection were uncommon. Radiolucency and periosteal reaction were associated with infection, though with low sensitivity.
Identifiants
pubmed: 33947369
doi: 10.1186/s12891-021-04170-3
pii: 10.1186/s12891-021-04170-3
pmc: PMC8097790
doi:
Substances chimiques
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
411Références
J Bone Joint Surg Am. 2005 Nov;87(11):2464-71
pubmed: 16264122
J Clin Microbiol. 2018 Nov 27;56(12):
pubmed: 30209185
J Bone Jt Infect. 2018 Jul 6;3(3):130-137
pubmed: 30013894
J Shoulder Elbow Surg. 2011 Dec;20(8):1275-81
pubmed: 22078323
Medicina (Kaunas). 2009;45(8):624-31
pubmed: 19773621
APMIS. 2017 Apr;125(4):353-364
pubmed: 28407423
Am Fam Physician. 2000 Nov 1;62(9):2053-60
pubmed: 11087187
J Clin Invest. 2003 Jun;111(12):1805-12
pubmed: 12813013
Pathol Res Pract. 2014 Dec;210(12):779-86
pubmed: 25454771
Clin Orthop Relat Res. 2017 Jul;475(7):1827-1836
pubmed: 28290115
Injury. 2018 Mar;49(3):505-510
pubmed: 28867644
J Orthop Res. 2011 Apr;29(4):617-22
pubmed: 21337398
Infect Dis Clin North Am. 2017 Jun;31(2):299-324
pubmed: 28366223
J Orthop Surg (Hong Kong). 2017 Jan;25(1):2309499017692712
pubmed: 28215118
Radiology. 1985 May;155(2):501-6
pubmed: 3157204
J Clin Microbiol. 2009 Jun;47(6):1878-84
pubmed: 19261785
J Orthop Trauma. 2020 Jan;34(1):8-17
pubmed: 31855973
Injury. 2018 Jun;49 Suppl 1:S83-S90
pubmed: 29929701
N Engl J Med. 2007 Aug 16;357(7):654-63
pubmed: 17699815
Bone Joint J. 2018 Dec;100-B(12):1542-1550
pubmed: 30499325
Spine (Phila Pa 1976). 1991 Feb;16(2):193-7
pubmed: 2011776
Injury. 2006 May;37 Suppl 2:S49-58
pubmed: 16651072
Bone Joint J. 2018 Jul;100-B(7):966-972
pubmed: 29954215
Bone Joint J. 2019 Feb;101-B(2):132-139
pubmed: 30700114
Surg Infect (Larchmt). 2014 Oct;15(5):548-59
pubmed: 24833084
J Bone Jt Infect. 2018 Aug 10;3(4):173-181
pubmed: 30155402
Eur Cell Mater. 2019 Jan 14;37:16-22
pubmed: 30644078
Clin Infect Dis. 2013 Jan;56(1):e1-e25
pubmed: 23223583
Biomed Res Int. 2017;2017:9146317
pubmed: 29130050
J Bone Joint Surg Am. 2001 Dec;83(12):1865-70
pubmed: 11741067
Radiology. 2015 Dec;277(3):826-32
pubmed: 26509226
Radiology. 1987 Dec;165(3):781-4
pubmed: 3685360