Implant-associated mycobacterium tuberculosis infection following surgical management of fractures: a retrospective observational study.
In this retrospective observational cohort study, we describe 17 patients out of 1775 treated for various fractures who developed mycobacterium tuberculosis (MTB) infection after surgery. The cohort comprised 15 men and two women with a mean age of 40 years (24 to 70). A total of ten fractures were open and seven were closed. Of these, seven patients underwent intramedullary nailing of a fracture of the long bone, seven had fractures fixed with plates, two with Kirschner-wires and screws, and one had a hemiarthroplasty of the hip with an Austin Moore prosthesis. All patients were followed-up for two years. In all patients, the infection resolved, and in 14 the fractures united. Nonunion was seen in two patients one of whom underwent two-stage total hip arthroplasty (THA) and the other patient was treated using excision arthoplasty. Another patient was treated using two-stage THA. With only sporadic case reports in the literature, MTB infection is rarely clinically suspected, even in underdeveloped and developing countries, where pulmonary and other forms of TB are endemic. In developed countries there is also an increased incidence among immunocompromised patients. In this paper we discuss the pathogenesis and incidence of MTB infection after surgical management of fractures and suggest protocols for early diagnosis and management.
JMFs ACPM Medical College, Morane, Sakri Road, Dhule, 424001 Post Box No 145, Maharashtra, India.
Y J
YJ
Mahale
JMFs ACPM Medical College, Morane, Sakri Road, Dhule, 424001 Post Box No 145, Maharashtra, India.
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Aga
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D042241:Early Diagnosis; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
Mycobacterium tuberculosis infection; fracture fixation; implants