Risk factors for infection after 46,113 intramedullary nail operations in low- and middle-income countries.
BACKGROUND
The fields of surgery and trauma care have largely been neglected in the global health discussion. As a result the idea that surgery is not safe or cost effective in resource-limited settings has gone unchallenged. The SIGN Online Surgical Database (SOSD) is now one of the largest databases on trauma surgery in low- and middle-income countries (LMIC). We wished to examine infection rates and risk factors for infection after IM nail operations in LMIC using this data.


METHODS
The SOSD contained 46,722 IM nail surgeries in 58 different LMIC; 46,113 IM nail operations were included for analysis.


RESULTS
The overall follow-up rate was 23.1 %. The overall infection rate was 1.0 %, 0.7 % for humerus, 0.8 % for femur, and 1.5 % for tibia fractures. If only nails with registered follow-up (n = 10,684) were included in analyses, infection rates were 2.9 % for humerus, 3.2 % for femur, and 6.9 % for tibia fractures. Prophylactic antibiotics reduced the risk of infection by 29 %. Operations for non-union had a doubled risk of infection. Risk of infection was reduced with increasing income level of the country.


CONCLUSIONS
The overall infection rates were low, and well within acceptable levels, suggesting that it is safe to do IM nailing in low-income countries. The fact that operations for non-union have twice the risk of infection compared to primary fracture surgery further supports the use of IM nailing as the primary treatment for femur fractures in LMIC.
Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. svenyoung@gmail.com
Sven
S
Young
Stein Atle
SA
Lie
Geir
G
Hallan
Lewis G
LG
Zirkle
Lars B
LB
Engesæter
Leif I
LI
Havelin
D000328:Adult; D019072:Antibiotic Prophylaxis; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome