The best treatment strategy for infected osteosyntheses is still debated. While hardware removal or eventually early device exchange may be necessary in most of the cases, temporary hardware retention until fracture healing can be a valid alternative option in others. Aim of the present study is to report the long-term results of 215 patients with infected osteosyntheses, treated according to the ICS (Infection, Callus, Stability) classification in two Italian hospitals. Patients classified as ICS Type 1 (N = 83) feature callus progression and hardware stability, in spite of the presence of infection; these patients were treated with suppressive antibiotic therapy coupled with local debridement in 18.1% of the cases, and no hardware removal until bone healing. Type 2 patients (N = 75) are characterized by the presence of infection and hardware stability, but no callus progression; these patients were treated as Type 1 patients, but with additional callus stimulation therapies. Type 3 patients (N = 57), showing infection, no callus progression and loss of hardware stability, underwent removal and exchange of the fixation device. Considering only the initial treatment, performed according to the ICS classification, at a minimum 5 years follow up, 89.3% achieved bone healing and 93.5% did not show infection recurrence. The ICS classification appears as a useful and reliable tool to help standardizing the decision-making process in treating infected osteosynthesis with the most conservative approach.

ICS classification system of infected osteosynthesis : long-term results / C.L. Romano, I. Morelli, D. Romano, E. Meani, L. Drago. - In: INJURY. - ISSN 0020-1383. - 49:3(2018), pp. 564-569. [10.1016/j.injury.2018.01.002]

ICS classification system of infected osteosynthesis : long-term results

I. Morelli
;
L. Drago
2018

Abstract

The best treatment strategy for infected osteosyntheses is still debated. While hardware removal or eventually early device exchange may be necessary in most of the cases, temporary hardware retention until fracture healing can be a valid alternative option in others. Aim of the present study is to report the long-term results of 215 patients with infected osteosyntheses, treated according to the ICS (Infection, Callus, Stability) classification in two Italian hospitals. Patients classified as ICS Type 1 (N = 83) feature callus progression and hardware stability, in spite of the presence of infection; these patients were treated with suppressive antibiotic therapy coupled with local debridement in 18.1% of the cases, and no hardware removal until bone healing. Type 2 patients (N = 75) are characterized by the presence of infection and hardware stability, but no callus progression; these patients were treated as Type 1 patients, but with additional callus stimulation therapies. Type 3 patients (N = 57), showing infection, no callus progression and loss of hardware stability, underwent removal and exchange of the fixation device. Considering only the initial treatment, performed according to the ICS classification, at a minimum 5 years follow up, 89.3% achieved bone healing and 93.5% did not show infection recurrence. The ICS classification appears as a useful and reliable tool to help standardizing the decision-making process in treating infected osteosynthesis with the most conservative approach.
Callus; Hardware retention; ICS classification; Infected osteosynthesis; Infection; Septic hardware; Stability; Adult; Aged; Clinical Decision-Making; Device Removal; Female; Fracture Healing; Fractures, Bone; Humans; Male; Middle Aged; Prosthesis-Related Infections; Reference Standards; Retrospective Studies; Surgical Wound Infection; Young Adult; Fracture Fixation, Internal; International Classification of Diseases
Settore MED/07 - Microbiologia e Microbiologia Clinica
2018
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/670050
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