Résumé
On a noté pendant les dix dernières années une chute du nombre d'infections postopératoires dans les ostéosynthèses des fractures du col fémoral, ce qui nous a amené à revoir tous les cas infectés de ces fractures. Lors d'une série rétrospective de 1 894 fractures du col fémoral, dont la plupart étaient dans d'autres études prospectives limitées, on a diagnostiqué un total de 15 infections profondes (0,8 %). Le staphylocoque doré était la bactérie la plus souvent en cause ; le diagnostic était établi plus de 4 mois après l'intervention chez 9 des patients. 658 patients sur les 1 894, auxquels il avait été administré des tétracyclines per-opératoires pour mesurer le renouvellement osseux, ont présenté deux infections profondes (0,3 %). Parmi les 1 236 patients restants, sans antibioprophylaxie, on a comptabilisé 13 infections profondes (1,0 %). Cette différence incite à recommander la prophylaxie antibiotique dans l'ostéosynthèse de la fracture du col du fémur. Huit des infections ont conduit à une arthroplastie totale de la hanche, habituellement en deux étapes ; il n'y eut pas de récidive d'infection, et la fonction de la hanche fut rétablie chez ces patients. Les 7 patients restants ayant subi une résection de type Girdlestone, n'eurent aucune récidive d'infection, mais leur résultat fonctionnel fut moins bon.
Summary
During the last decade a decrease in postoperative infections in femoral neck fracture osteosynthesis was noted which led us to review all femoral neck fractures for infection. In a retrospective series of 1894 femoral neck fractures, the majority of which were included in other limited prospective studies, a total of 15 deep infections were diagnosed (0.8%). Staph. aureus was the most common bacterium cultured, and the diagnosis was established more than 4 months postoperatively in 9 of the patients. A total of 658 of the 1894 patients, who had pre- or peroperative tetracycline administration for measuring bone turnover, had two deep infections (0.3%). Among the remaining 1236 patients without antibiotic prophylaxis, 13 deep infections were diagnosed (1.0%). This difference suggests considering antibiotic prophylaxis in femoral neck fracture osteosynthesis. Eight of the infections led to THR, usually two-stage ; no signs of recurrent infection ensued, and the hip function of these patients was restored. The remaining 7 patients had Girdlestone procedures, also without recurrent infection, but with inferior functional outcome.
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Nilsson, L.T., Strömqvist, B., Thorngren, K.G. et al. Deep infection following femoral neck fracture osteosynthesis. Orthop Traumatol 3, 313–315 (1993). https://doi.org/10.1007/BF01803944
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DOI: https://doi.org/10.1007/BF01803944