Objective:

To analyze the occurrence of acute knee sepsis following intramedullary nailing of open tibial shaft fractures using intra- or extra-articular approaches.

Approach:

• Study Design: Retrospective cohort analysis of 293 patients treated at 2 academic Level I trauma centers from January 2010 to December 2023.
• Patient Population: Included 295 fractures with at least 3 months of follow-up, comparing intra-articular (90 fractures) and extra-articular (205 fractures) nailing approaches.
• Outcomes Measured: Primary outcome was acute knee sepsis; secondary outcomes included deep and superficial infection, nonunion, and hardware removal.

Key Findings:

• Acute knee sepsis occurred in 0.7% (n = 2) of fractures.
• Sepsis rates were 1.1% for intra-articular and 0.5% for extra-articular approaches, with no statistically significant difference.
• Deep infection rates were 9% for both approaches; superficial infection rates were 4% for intra-articular and 5% for extra-articular.
• Both cases of acute knee sepsis were diagnosed about 2 months following intramedullary nailing, and cultures from both patients grew methicillin-susceptible Staphylococcus aureus.

Interpretation:

The study was underpowered to determine relative risk of acute knee sepsis associated with both intra-articular and extra-articular nailing techniques.

Limitations:

• Retrospective design may have missed complications occurring later or treated elsewhere.
• Small number of knee sepsis events limits the ability to perform subgroup analyses.

Conclusion:

The study highlights the occurrence of acute knee sepsis associated with both nailing techniques.

Sources:

• OTA International