Mohd Yusof, Nazri
(2023)
Implant related infection: to retain or remove.
In: 5th Malaysian-International ASAMI-LLRS Scientific Meeting 2023, 11-13 September 2023, Lexis Hibiscus Port Dickson.
(Unpublished)
Abstract
Fracture fixation devices are the most common implant inserted in the human body, accounting for 2 million cases annually in the US. Unfortunately, it is also the most common implant-related infection accounting for 100 thousand cases per year.
The initial approach was to let the fracture heal first before tackling infection because they believe of fracture can heal despite infection in the present of a stable implant.
However, as our understanding of the microbiology especially on the biofilm, the tendency is to remove the implant is stronger. The biofilm complex is a unique bacterial colony in which the bacteria stick together on the surface of the implant and are embedded in an extracellular matrix which is protected from the immune surveillance and forms a barrier to the antibiotic. Within weeks the bacteria colony already attached irreversibly to the implant surface which is impossible to remove without removing the implant.
Removal of the implant also allows more thorough debridement of the surrounding unhealthy bone and soft tissue. It also allows adequate microbiology samples and implants to be sent for sonication culture and sensitivity.
This approach is to eradicate infection first before fracture healing and reconstruction of bone defect. The fracture is usually stabilised using the external fixator and reconstructed bone defect with bone transport.
However, retained of implants have a high success rate if the infection occurs early, in a stable implant, with good soft tissue coverage, in a healthy host and the bacteria is sensitive to oral antibiotics.
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