Microbiology sampling in Fracture Related Infection

Authors:
N Uren, M Scotcher, J Round

Hospital:
University Hospital Southampton NHS trust

Introduction
The intra-medullary Gamma nail is the most used fixation device for neck of femur fractures at UHS. Fracture-related infection (FRI) is a catastrophic complication associated with fractures. FRI is common, but often diagnosed late, and often has significant impact on the patient and healthcare system due to the need for further surgery, extended hospital stays, reduced quality of life and high health costs. This study aims to evaluate whether failed Gamma nails treated at a major trauma centre in the United Kingdom are undergoing intraoperative microbiology sampling routinely, as outlined by the FRI Consensus Group in 2020.

Method
Electronic patient record systems were reviewed over a 4-year period between 2018–2022 to identify patients who had a surgical fixation, and those who required revision surgery. Our CHARTs database at UHS identified whether sampling had taken place during revision surgery, and the number of samples taken.  

Results
1041 Gamma nails were performed during the 4-year period. 60 of these implants failed fixation, 52 of these undergoing revision surgery at our hospital. From the 52 cases, only 56% had intra-operative sampling, with an average of 9 samples sent per case. Intraoperative sampling confirmed infection in 25% of cases.

Conclusion
UHS performed microbiology sampling in only 56% of failed Gamma nail cases over a 4-year period. The data shows that UHS falls below the guidelines set by the FRI Consensus Group. This study highlights the importance of a standardised protocol to ensure routine intra-operative sampling during Gamma nail revision surgery.