• Orthopaedics Clinical Trials
• Infections

• Orthopaedics Clinical Trials
• Infections
• Orthopaedics

Brett D. Crist, MD, University of Missouri, Columbia, Missouri, USA, discussed a prospective randomized trial [NCT00829621] that compared negative-pressure wound therapy (NPWT) and standard gauze dressings over primarily closed surgical incisions in outcomes of hip, pelvis, and acetabular fracture surgery.

Orthopaedic surgical site infections exact huge treatment costs, can double the rehospitalization rate, and extend hospital stays [Whitehouse JD et al. Infect Control Hosp Epidemiol. 2002]. Debridement is not effective in about 30% of cases of infected fractures after open reduction and internal fixation [Rightmire E et al. Clin Orthop Relat Res. 2008]. Letournel found that infection following acetabular fracture surgery occurs in ≤ 5% of cases for the most common approaches; obese individuals are at heightened risk [Porter SE et al. J Orthop Trauma. 2008].

NPWT, which reportedly decreases wound-related complication in high-risk [Stannard JP et al. J Trauma. 2006] and acetabular fractures [Reddix RN Jr et al. J Surg Orthop Adv. 2010], applies a vacuum through a specialized dressing to the wound to accelerate healing.

The aim of the present study was a prospective comparison of NPWT and standard gauze dressings over primarily closed surgical incisions—a popular surgical option for hip, pelvis, and acetabular fractures. The techniques were compared in terms of postoperative surgical wound drainage, infections, and cost-effective hospitalization. A multitude of secondary characteristics were compared.

Reflecting the anatomic similarity of the affected bones and the similar surgical approach typically used, patients with fractures of the hip, pelvis, and acetabulum were grouped. The 115 patients were randomized to receive NPWT for at least 2 days (n = 55) or standard gauze (n = 60). They were followed up for 12 months; 49 NPWT-treated patients and 41 standard gauze-treated patients completed the follow-up, meaning that the study was underpowered. The types of injuries treated in each group are shown in Table 1.

At 12 months postoperatively, deep infection had occurred in 5 of 49 NPWT-treated patients (10.2%) and 2 of 41 gauze-treated patients (4.9%; P = .44); while the difference was not significant, NPWT-treated patients were 2.3 times more likely to develop a deep infection. All deep infections occurred in patients with acetabular fractures involving the posterior wall or column requiring a Kocher-Langenbeck surgical exposure; of these 7 patients, 6 had medical comorbidities.

Deep infections were not associated with body mass index (P = .54), contrary to a study of morbidly obese patients [Porter SE et al. J Orthop Trauma. 2008] but consistent with a study of obese patients treated with NPWT [Reddix RN Jr et al. Am J Orthop (Belle Mead NJ). 2009]. Those patients that ended up with infections spent significantly more time in the intensive care unit (P = .015) and had significantly prolonged hospitalization (P ≤ .001). A cost comparison proved impossible.

Acknowledging the limitations of sample size and grouping of patients with different fractures, Dr Crist concluded that NPWT may not reduce the risk of infection, especially in patients with acetabular fractures involving the posterior wall or column who have other comorbidities.

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