High rate of undetected infections in failed osteosynthesis of pertrochanteric fractures

Abstract

OBJECTIVE: The objective of this study was to assess the incidence of infection in patients with cut-out after PFF osteosynthesis. METHODS: Design: Retrospective cohort study. Setting: Third-level trauma center. Patient selection criteria: Patients presenting with a cut-out following proximal femur fracture (PFF) (OTA/AO 31A) osteosynthesis, between January 2007 to December 2020. Outcome Measurements: The primary outcome was infection according to EBJIS criteria. RESULTS: Sixty-seven patients presenting with a cut-out were included, with mean age of 83.3 years (range 63-96) and 51 (76.1%) were women. Of all cases, 16 (24.7%) presented a concomitant infection. The presence of concomitant infection was suspected preoperatively in only 3 of the cases. A subgroup analysis was performed between the cases with infection and those without infection, the groups being comparable in terms of demographic data and postoperative radiological criteria. Patients with underlying infection had a higher rate of surgical wound complication (56.3% vs 22%, p = 0.014) and higher rates of leukocytosis (11.560 vs 7.890, p = 0.023). Conclusion: Faced with a cut-out after osteosynthesis of a proximal femur fracture, underlying infection should be considered as a possible etiological factor. Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.