Outcomes of Aseptic, Septic, and Occult Infected Index Nonunion Repair: A Retrospective Comparive Study
Poster #: 109
Session/Time: B
Author:
Kai Uwe Rossbach, BS, MS
Mentor:
Justin Haller, BS, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
The purpose of this program is to compare the effectiveness of index nonunion surgery for occult-infected nonunion (ON) with aseptic (AN) and septic nonunion (SN) in patients identified using the fracture-related infection (FRI) criteria. This study also compared success rate of achieving union of bone grafting versus no bone grafting in the treatment of occult infected nonunion.
METHODS:
Patients diagnosed with nonunion at a single level 1 trauma center between 2013-2023 were retrospectively reviewed. Patients with incomplete culture data, missing inflammatory labs, or lack of 6 month follow-up were excluded. Patients were categorized into AN, SN, or ON groups using FRI criteria. Successful union after nonunion surgery without need for additional surgical interventions was evaluated. ON patients were organized into bone graft (ONBG) and no bone graft (ONNBG) groups to compare successful nonunion surgery. Multivariate regression was used to compare outcomes while controlling for gender, ASA, and diabetes.
RESULTS:
A total of 208 patients with nonunion fractures were included in the analysis, 125 AN, 54 SN, and 29 ON. ON patients were significantly more likely to be infected by a low virulence organism (82.8% vs 9.3%, p<0.001). The overall success rate of index nonunion surgery was 67.8%. ON had the highest success rate (79.3%), followed by AN (72.8%) and SN (50.0%) (p=0.004). Recurrent infections were significantly lower in AN (16.0%) and ON (10.3%) compared to SN (35.2%) (p=0.005). Regression analysis demonstrated that surgery success was significantly lower in SN patients (OR=0.38, p=0.009); ON and AN had similar success (OR=1.58, p=0.4). Among ON patients, 21 underwent bone grafting while 8 did not, which may have contributed to the observed but statistically non-significant difference in union rates (ONBG 76.2% vs. ONNBG 87.5%; p=0.65).
CONCLUSION:
Index nonunion surgery in SN patients is associated with worse outcomes compared to AN and ON patients identified with the FRI criteria. Surgery success in ON is comparable to AN cases, suggesting that low-virulence infections do not significantly compromise nonunion surgery effectiveness. Bone grafting in occult infections did not impair nonunion surgery success in this small sample.
The purpose of this program is to compare the effectiveness of index nonunion surgery for occult-infected nonunion (ON) with aseptic (AN) and septic nonunion (SN) in patients identified using the fracture-related infection (FRI) criteria. This study also compared success rate of achieving union of bone grafting versus no bone grafting in the treatment of occult infected nonunion.
METHODS:
Patients diagnosed with nonunion at a single level 1 trauma center between 2013-2023 were retrospectively reviewed. Patients with incomplete culture data, missing inflammatory labs, or lack of 6 month follow-up were excluded. Patients were categorized into AN, SN, or ON groups using FRI criteria. Successful union after nonunion surgery without need for additional surgical interventions was evaluated. ON patients were organized into bone graft (ONBG) and no bone graft (ONNBG) groups to compare successful nonunion surgery. Multivariate regression was used to compare outcomes while controlling for gender, ASA, and diabetes.
RESULTS:
A total of 208 patients with nonunion fractures were included in the analysis, 125 AN, 54 SN, and 29 ON. ON patients were significantly more likely to be infected by a low virulence organism (82.8% vs 9.3%, p<0.001). The overall success rate of index nonunion surgery was 67.8%. ON had the highest success rate (79.3%), followed by AN (72.8%) and SN (50.0%) (p=0.004). Recurrent infections were significantly lower in AN (16.0%) and ON (10.3%) compared to SN (35.2%) (p=0.005). Regression analysis demonstrated that surgery success was significantly lower in SN patients (OR=0.38, p=0.009); ON and AN had similar success (OR=1.58, p=0.4). Among ON patients, 21 underwent bone grafting while 8 did not, which may have contributed to the observed but statistically non-significant difference in union rates (ONBG 76.2% vs. ONNBG 87.5%; p=0.65).
CONCLUSION:
Index nonunion surgery in SN patients is associated with worse outcomes compared to AN and ON patients identified with the FRI criteria. Surgery success in ON is comparable to AN cases, suggesting that low-virulence infections do not significantly compromise nonunion surgery effectiveness. Bone grafting in occult infections did not impair nonunion surgery success in this small sample.