title: Analysis of postoperative knee sepsis after retrograde nail insertion of open femoral shaft fractures.
abstract: OBJECTIVE
  Retrograde nailing of open femoral fractures has presumed increased risk of knee sepsis. Our hypothesis was that the incidence of secondary knee infection after retrograde nailing of open femoral fractures is low.
  
  
  METHODS
  Retrospective, multicenter.
  
  
  METHODS
  Four Level I trauma centers.
  
  
  METHODS
  A retrospective review of prospective trauma registries and fracture databases identified all open femoral fractures treated with retrograde intramedullary nailing from January 1, 2003, through February 15, 2007. Patients with ballistic injuries and those with less than 1 month follow up were excluded. Ninety-three open femoral fractures were identified in 90 patients. We defined a septic knee as a knee with infection that required reoperation with arthrotomy or arthroscopy. Infections at an open fracture site were defined as those treated with local irrigation and débridement and intravenously and/or orally administered antibiotics.
  
  
  METHODS
  Open femoral shaft fractures treated with a retrograde approach.
  
  
  METHODS
  Occurrence of an ipsilateral postoperative septic knee.
  
  
  RESULTS
  One acute septic knee was identified (1.1%; 95% confidence interval, 0.0%-3.2%) noted at time of repeat irrigation and débridement of a massive degloving wound that left no skin coverage over the knee. We also observed one late knee sepsis 2.5 years after the index procedure occurring after quadricepsplasty. The nail had been removed 1.5 years before surgery, so we did not include that case in our knee sepsis rate. Two additional infections at the open wound site did not involve the knee.
  
  
  CONCLUSIONS
  Previous publications have argued that retrograde nailing of open femoral fractures provides a potential conduit for knee infection. Our data show that risk of a septic knee as a direct result of retrograde nailing of an open femoral fracture is relatively low (1.1%; 95% confidence interval, 0.0%-3.2%). To our knowledge, this is the first case series to document the relative safety associated with retrograde nailing of open femoral fractures.
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. rvo3@yahoo.com
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
authors.forename: Kevin
authors.initials: K
authors.lastname: Riche
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Cannada
authors.forename: Michael
authors.initials: M
authors.lastname: Hennessy
authors.forename: Marcus F
authors.initials: MF
authors.lastname: Sciadini
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Shi
authors.forename: Mathew
authors.initials: M
authors.lastname: Woodford
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001858:Bone Nails; D016208:Databases, Factual; D003646:Debridement; D005260:Female; D005264:Femoral Fractures / Q000382:microbiology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D005597:Fractures, Open / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents