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Forschungsdatenbank PMU-SQQUID

Treatment of infection following intramedullary nailing of tibial shaft fractures-results of the ORS/ISFR expert group survey.
Mauffrey, C; Hak, DJ; Giannoudis, P; Alt, V; Nau, C; Marzi, I; Augat, P; Oh, JK; Frank, J; Mavrogenis, A; Flecher, X; Argenson, JN; Gavaskar, A; Rojas, D; Bedeir, YH;
Int Orthop. 2019; 43(2): 417-423.
Originalarbeiten (Zeitschrift)


Augat Peter


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.
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.
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 (< 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.
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.
Clinical Question.

Find related publications in this database (Keywords)

Tibia infection
Intramedullary nailing
Nonunion tibia
Tibia fractures
Treatment algorithm
Survey on nonunion