- •SSRF hardware infection increases hospital and ICU duration of stay.
- •Antibiotic beads suppress SSRF hardware infection to allow bony union.
- •Hemorrhagic shock on admission and increased BMI are infection risk factors.
Surgical stabilization of rib fractures (SSRF) can be used to improve pulmonary mechanics; however, hardware infection is a morbid complication. Antibiotic impregnated beads have been used to suppress infection in orthopedic practices. We aimed to determine the efficacy of antibiotic beads for infected and at-risk SSRF hardware.
This is a single institution retrospective review of adults (18 years or older) that received SSRF between 2009 and 2017. Infected and at-risk hardware were managed with antibiotic beads. The primary outcome was bony union of rib fractures.
There were 285 SSRF patients. Infection rate was 3.5%. Antibiotic beads were placed in 17 patients – 9 for infected hardware and 8 for prophylaxis. Increased body mass index (p = 0.04) and hemorrhagic shock at admission (p = 0.03) were risk factors for infection. There was 100% bony union post-operatively.
SSRF hardware infection is morbid. Antibiotic beads can salvage SSRF hardware until bony union.
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- Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline.J Trauma Acute Care Surg. 2016; 73: S351-S361
- Western trauma association critical decisions in trauma: management of rib fractures.J Trauma Acute Care Surg. 2017; 82: 200-203
- Rib fracture fixation in the 65 years and older population: a paradigm shift in management strategy at a level I trauma center.J Trauma Acute Care Surg. 2017; 82: 524-527
- A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures.J Trauma Acute Care Surg. 2016; 80: 187-194
- Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.J Am Coll Surg. 2013; 216: 924-932
- Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma.J Trauma Acute Care Surg. 2017; 82: 618-626
- Rib fracture stabilization in patients sustaining blunt chest injury.Am Surg. 2006; 72: 307-309
- Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation.J Thorac Cardiovasc Surg. 1995; 110: 1676-1680
- Acute infections after fracture repair: management with hardware in place.Clin Orthop Relat Res. 2008; : 466-472
- Systematic review and meta-analysis of the additional benefit of local prophylactic antibiotic therapy for infection rates in open tibia fractures treated with intramedullary nailing.Int Orthop. 2014; 38: 1025-1030
- A prospective, randomized clinical trial comparing an antibiotic-impregnated bioabsorbable bone substitute with standard antibiotic-impregnated cement beads in the treatment of chronic osteomyelitis and infected nonunion.J Orthop Trauma. 2010; 24: 483-490
- Effects of loading concentration, blood and synovial fluid on antibiotic release and anti-biofilm activity of bone cement beads.J Contr Release. 2017; 248: 24-32
- Infected hardware after surgical stabilization of rib fractures: outcomes and management experience.J Trauma Acute Care Surg. 2016; 80: 819-823
- The release of gentamicin from polymethylmethacrylate beads. An experimental and pharmacokinetic study.J Bone Joint Surg Br. 1978; 60-B: 270-275
- Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection.Biomaterials. 2004; 25: 545-556
- Local antibiotic therapy strategies in orthopaedic trauma: Practical tips and tricks and review of the literature.Injury, Int. J. Care Injured. 2015; 46: 1447-1456
- Combined local and systemic antibiotic delivery improves eradication of wound contamination: and animal experimental model of contaminated fracture.Bone Jt J. 2015; 9797: 1423-1427
- Antibiotic-laden PMMA bead chains for the prevention of infection in compound fractures: current state of the art.Eur J Orthop Surg Traumatol. 2015; 25: 969-974
- Local antibiotic therapy for severe open fractures: a review of 1085 consecutive cases.J Bone Joint Surg. 1995; 77-B: 93-97
Published online: March 01, 2019
Accepted: February 26, 2019
Received in revised form: February 21, 2019
Received: August 14, 2018
☆Presentation: This was presented as a podium presentation at Western Trauma Association 48th Annual Meeting in Whistler, British Columbia on February 27, 2018.
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