title: Sonication of intramedullary nails: clinically-related infection and contamination.
abstract: OBJECTIVE
  Sonication is currently considered the best procedure for microbiological diagnosis of implant-related osteoarticular infection, but studies in nail-related infections are lacking. The study aim was to evaluate implant sonication after intramedullary nail explantation, and relate it to microbiological cultures and clinical outcome.
  
  
  METHODS
  A study was performed in two University Hospitals from the same city. Thirty-one patients with implanted nails were prospectively included, whether with clinical infection (8 cases) or without (23 cases). Retrieved nails underwent sonication according a previously published protocol. The clinical and microbiological outcome patient was related to the presence of microorganisms in the retrieved implant.
  
  
  RESULTS
  Positive results appeared in 15/31 patients (9 with polymicrobial infections) almost doubling those clinically infected cases. The most commonly isolated organisms were Staphylococcus epidermidis (19.2 %) and Staphylococcus aureus (15.4 %). A significant relationship was found between the presence of positive cultures and previous local superficial infection (p=0.019). The presence of usual pathogens was significantly related to clinical infection (p=0.005) or local superficial infection (p=0.032). All patients with positive cultures showed pain diminution or absence of pain after nail removal (15/15), but this only occurred in 8 (out of 16) patients with negative cultures.
  
  
  CONCLUSIONS
  In patients with previously diagnosed infection or local superficial infection, study of the hardware is mandatory. In cases where pain or patient discomfort is observed, nail sonication can help diagnose the implant colonization with potential pathogens that might require specific treatment to improve the final outcome.
authors: Departments of Clinical Microbiology, IIS-Fundacin Jimnez Daz, Madrid, Spain.
authors: J
authors: J
authors: Esteban
authors: E
authors: E
authors: Sandoval
authors: J
authors: J
authors: Cordero-Ampuero
authors: D
authors: D
authors: Molina-Manso
authors: A
authors: A
authors: Ortiz-Pérez
authors: R
authors: R
authors: Fernández-Roblas
authors: E
authors: E
authors: Gómez-Barrena