Infections After Fracture - Symptoms, Diagnosis, and Treatment

Introduction:

Infections can happen after the injury or while treating the fracture. Both affect the healing process by reducing or losing blood or oxygen supply, resulting in muscle wasting, bone cell death, and ischemia (lack of oxygen to the muscle). Patients experience fever, chills, pain, redness, swelling, and inability to move the limbs. Left untreated or unnoticed, it can end in drastically ill or fatal conditions, even leading to death.

How Do Infections Occur After a Fracture?

A person's chances of getting infected after a fracture can be acute or chronic. The acute causes are based on the fracture type or the surgery. Chronic infections occur after fracture fixation or due to systemic conditions. Based on the type of fracture, the one more prone to infections is an open fracture.

• Open Fracture: Open fractures are a type of fracture where the bone is broken into fragments, with the cracked or broken bone seen through the skin. During this type of fracture, the skin, which acts as a protective barrier, is torn, allowing a passage for the communication of infection. The source of infection can be from the agents causing fractures like contaminated surfaces or things.

• While Performing the Surgery: Here the infection occurs when the surface comes in contact with an infected source like an unnoticed contaminated instrument, or as a secondary infection from another source like an abscess or fistulas.

• Chronic Infections: Infections after fracture can occur due to multiple reasons, an external factor, or a compromised immune system. The factors for disease are:

  • Infection After Fracture Fixation: This occurs as a chronic condition long after the surgical procedure, which causes the failure of the fixed splints or plaque formation (accumulation of bacteria over the placed implants, plates, or screws). The cause can be a long-term underlying non-active infection or constant compression at the fixation site.

• Systemic Causes:

  • Diabetes Mellitus: The increase in blood sugar levels creates a favorable environment for the growth and multiplication of the organisms.

  • Autoimmune and Inflammatory Conditions: Diseases like HIV (human immunodeficiency virus), lupus, arthritis, tuberculosis, anemia, or immune suppression (compromised immunity due to increased drug intake) where the body acts against itself, making it more prone to infection.

What Are the Symptoms of Infection After Fracture?

The clinical symptoms of infection are:

• Pain.

• Redness.

• Swelling.

• Fever.

• Chills.

• Pus discharge.

• Night sweats.

• Failure of the prosthesis.

• Decaying of bone.

How Are the Infections Diagnosed?

Diagnosing the infections after fracture at a very early stage is essential as it can have a disastrous effect if not treated or treated late. The diagnosis of these conditions can be complicated as no external signs are seen until late. The tests used for assessing the infections are:

• Radiographs (X-rays): Radiographic images are used to examine the site of infection, the presence of any abscess (collection of pus in a localized area), or to see the thickness of the bone.

• Laboratory Diagnosis: The blood samples are taken for culture. The cultures test done is used to know:

• The white blood cell (WBC) count.

• Red cell sedimentation rate (ESR).

• C- reactive protein (CRP).

• The increase or decrease of these values indicates the level of infection in the body.

• Computed Tomography (CT): CT is used for examining the infection site at precession compared to a radiograph, as it is a three-dimensional image.

• Magnetic Resonance Imaging (MRI): MRI detects soft tissue damage or edema around the bone and at the site of infection.

What Are the Infections Seen After Fracture?

The infections associated with a fracture are:

Superficial Infections - Superficial infections are mild infections characterized by redness, pain, swelling, or pus discharge from the wound's surface. Left untreated, it can progress to conditions like gangrene (moist infected skin) or cell necrosis (skin decay).

Osteomyelitis - Osteomyelitis is a clinical condition seen by the infection of bone or bone marrow when the infection from another source comes in contact with the bone through blood. It is an inflammation of the bone and structures associated with the bone, like marrow and surrounding ligaments. The patient shows the following clinical symptoms:

• Fever.

• Tiredness.

• Irritability.

• Inability to move the limbs.

• Local redness and tenderness.

Osteonecrosis: Osteonecrosis means the death of bone cells. This clinical condition occurs for multiple reasons, one of which is an infection occurring after osteomyelitis or septic-induced cellular infection. The clinical features are:

• Pain.

• Movement restriction.

Septic Arthritis: Septic arthritis is a clinical condition with the primary cause of infection due to trauma. Septic arthritis is considered an emergency, leading to drastic joint changes when left untreated. It can also end up being a fatal condition. It is seen both in adults and children. The reason for the cause are:

• Bacterial.

• Previously infected joint or trauma.

• Compromised immunity.

How to Treat the Infection?

The management of infection post-fracture is performed in two ways, conservative management and surgical management. The treatment of infection after fracture is managed by following specific protocols. They are:

• Ruling out other reasons causing such infections.

• The goal for treatment should be preserving the maximum structure possible and restoring the function of the bone.

• Healing of the bone should be the main aim rather than suppression of a person's immunity with antibiotics.

• Removal of the infected material like screws or plates should be done to avoid secondary infection.

Conservative Management: Conservative management is the nonsurgical management of the condition using medication. The medical management done are:

• Administration of systemic antibiotics through intravenous injections.

• Wound debridement and irrigation are done at the fracture site with antiseptic within 24 hours of infection.

• The wound debridement must include complete removal of the infected portion.

• The patient is treated with localized antiseptics at the injury site with localized antibiotics.

• Drains or tubes are placed for the removal of pus.

• Antibiotic therapy is followed for six to 12 weeks.

Surgical Management: Surgical management is the method of treating the infection through surgery. Suppose the wound is not debrided properly. Biofilm or callus forms on the surface. Also, if the placed implants cause the infection, then both the callus and the failed implant or plates are removed to allow healing. Surgical infection management after fracture requires multiple visits to the surgical unit.

Conclusion:

Infection of the bone is an arduous process to eradicate, and it takes an extensive healing period with recurrent visits and constant follow-ups. When the protocols are not followed or not treated on time, the complications can extend even to removing a limb. But when the infection is successfully treated with long-term antibiotics and a long healing period, patients show a good recovery without any serious problems.