Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and Predictors

Abstract

Background: <br/> <span style="font-size: xx-small; font-family: ArialMT;">Little is known about trends and predictors of hardware related infection following open reduction and </span>internal fixation (ORIF) of extremity fractures, one of the major causes of failure following ORIF. The present study was designed and conducted to determine trends and predictors of infection-related hardware removal following ORIF of extremities using a nationally representative database. <br/>Methods: <br/> <span style="font-size: xx-small; font-family: ArialMT;">We used Nationwide Inpatient Sample data from 2002 to 2011 to identify cases of ORIF following </span>upper and lower extremity fractures, as well as cases that underwent infection-related hardware removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related hardware removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year. <br/> Results: <br/><span style="font-size: xx-small; font-family: ArialMT;">For all ORIF procedures, the highest rate of hardware removal related to infection was observed in tarsal </span>fractures (5.56%), followed by tibial (3.65%) and carpal (3.37%) fractures. Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Tarsal fractures(odds ratio (OR)=1.06, 95% confidence interval (CI): 1.04-1.09, <em><span style="font-size: xx-small; font-family: Arial-ItalicMT;"><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;">P</span></em></span></em><span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;"><0.001), tibial fractures (OR=1.04, 95% CI: 1.03-1.06, </span></span><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;"><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;">P </span></em></span></em><span style="font-size: xx-small; font-family: ArialMT;"><0.001) and those patients with diabetes </span>mellitus (OR=2.64, 95% CI: 2.46-2.84, <em><span style="font-size: xx-small; font-family: Arial-ItalicMT;"><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;">P</span></em></span></em><span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;"><0.001), liver disease (OR=2.04, 95% CI: 1.84- 2.26, </span></span><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;"><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;">P </span></em></span></em><span style="font-size: xx-small; font-family: ArialMT;"><0.001), and rheumatoid </span>arthritis (OR=2.06, 95% CI:1.88-2.25 <em><span style="font-size: xx-small; font-family: Arial-ItalicMT;"><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;">P </span></em></span></em><span style="font-size: xx-small; font-family: ArialMT;"><0.001) were the main predictors of infection-related removals; females were </span>less likely to undergo removal due to infection (OR= 0.61, 95% CI: 0.59-0.63 <em><span style="font-size: xx-small; font-family: Arial-ItalicMT;"><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;">P </span></em></span></em><span style="font-size: xx-small; font-family: ArialMT;"><0.001).</span> <br/>Conclusions: <br/> <span style="font-size: xx-small; font-family: ArialMT;">Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. </span>Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related hardware removal. The study identified some risk factors for hardwarerelated infection following ORIF, such as diabetes, liver disease, and rheumatoid arthritis,that should be studied further in an attempt to implement strategies to reduce rate of infection following ORIF.