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Aim <p>Our primary aim was to describe the microbiology of long-bone non-unions after open fracture. Then, we sought to determine the clinical and biological factors associated with the risk of positive intraoperative tissue cultures and the outcome after non-union surgery.</p> Methods <p>We retrospectively selected patients &gt; 18 years, who had a primary planned surgical treatment of long-bone non-union after diaphyseal open fracture, with no previous history of infection. Infection was confirmed when growth of the same micro-organism was observed from at least two bone/tissue samples obtained at the time of non-union surgery.</p> Results <p>From 2005 to 2021, 85 patients (64 males, 21 females) were included, with a mean age of 38.5 ± 15 years (18–75 years) at the time of non-union surgery. Anatomic regions included the tibia (58 cases), femur (21 cases), and humerus (6 cases). Cultures were positive in 29 cases (34%), including nine polymicrobial infections (31%), with coagulase-negative <i>Staphylococcus species</i> (<i>n</i> = 10) and <i>Staphylococcus aureus</i> (<i>n</i> = 9) being the most prevalent bacteria, followed by <i>Cutibacterium acnes</i> (<i>n</i> = 5), and <i>Pseudomonas</i> aeruginosa (<i>n</i> = 2). The risk of infection correlated with diabetes mellitus (<i>p</i> = 0.0017), the presence of a fistula (<i>p</i> = 0.001), and the type of index wound according to Cauchoix-Duparc (<i>p</i> = 0.03). The risk of postoperative complications and the need for additional surgery, notably for persistent non-union, were higher in patients with an infected non-union.</p> Conclusions <p>An underlying low-grade indolent infection was found in a third of cases of presumed aseptic long-bone non-union following an open fracture. The risk of infection was associated with diabetes mellitus, the presence of a fistula, and greater severity of the initial wound. In these cases, the risk of septic failure was almost three times higher as compared to patients with negative cultures.</p> Level of evidence <p>Retrospective study, Level III.</p>

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Microbiology, risk factors, and clinical outcomes of low-grade infection in long-bone diaphyseal non-union after open fracture

  • 期刊论文

  • 发表日期：

    2025年11月13日

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  • Quentin Vanco,
  • David Boutoille,
  • Stephane Corvec,
  • Raphael Lecomte,
  • Antoine Asquier-Khati,
  • Louise Ruffier d Epenoux,
  • Guy Pietu,
  • Christophe Nich

摘要

Aim

Our primary aim was to describe the microbiology of long-bone non-unions after open fracture. Then, we sought to determine the clinical and biological factors associated with the risk of positive intraoperative tissue cultures and the outcome after non-union surgery.

Methods

We retrospectively selected patients > 18 years, who had a primary planned surgical treatment of long-bone non-union after diaphyseal open fracture, with no previous history of infection. Infection was confirmed when growth of the same micro-organism was observed from at least two bone/tissue samples obtained at the time of non-union surgery.

Results

From 2005 to 2021, 85 patients (64 males, 21 females) were included, with a mean age of 38.5 ± 15 years (18–75 years) at the time of non-union surgery. Anatomic regions included the tibia (58 cases), femur (21 cases), and humerus (6 cases). Cultures were positive in 29 cases (34%), including nine polymicrobial infections (31%), with coagulase-negative Staphylococcus species (n = 10) and Staphylococcus aureus (n = 9) being the most prevalent bacteria, followed by Cutibacterium acnes (n = 5), and Pseudomonas aeruginosa (n = 2). The risk of infection correlated with diabetes mellitus (p = 0.0017), the presence of a fistula (p = 0.001), and the type of index wound according to Cauchoix-Duparc (p = 0.03). The risk of postoperative complications and the need for additional surgery, notably for persistent non-union, were higher in patients with an infected non-union.

Conclusions

An underlying low-grade indolent infection was found in a third of cases of presumed aseptic long-bone non-union following an open fracture. The risk of infection was associated with diabetes mellitus, the presence of a fistula, and greater severity of the initial wound. In these cases, the risk of septic failure was almost three times higher as compared to patients with negative cultures.

Level of evidence

Retrospective study, Level III.