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Infection after bone plate fixation is a relatively serious complication. If not handled properly, it may lead to adverse consequences such as nonunion of fractures, loosening of internal fixators, and even the need for amputation. The following are the treatment methods for infection after bone plate fixation:
Systemic treatment
Antibiotic application
Empirical medication: In the early stage of infection, when the pathogen has not yet been identified, broad-spectrum antibiotics can be empirically selected for treatment based on the location of the infection, its severity, and common pathogenic bacteria. For example, for superficial wound infections, first-generation or second-generation cephalosporins may be selected; If Gram-negative bacterial infection is suspected, aminoglycoside antibiotics can be used in combination.
Targeted medication: Timely collect wound secretions, blood and other samples for bacterial culture and drug sensitivity tests. Adjust the use of antibiotics based on the test results and select antibiotics that are sensitive to pathogenic bacteria to improve the therapeutic effect. If Staphylococcus aureus is cultivated and is sensitive to vancomycin, vancomycin can be selected for treatment.
Course of medication: The course of antibiotic use should be sufficient. Generally, for superficial infections, it may take 1 to 2 weeks, while for deep infections or severe infections such as osteomyelitis, it may take 4 to 6 weeks or even longer to ensure complete elimination of pathogenic bacteria and prevent recurrence of infection.
Supportive treatment
Nutritional support: Infection can lead to an increase in the patient’s physical consumption, so it is necessary to enhance nutritional support. Encourage patients to consume foods rich in protein, vitamins and minerals, such as meat, fish, eggs, fresh vegetables and fruits, etc. For patients who are unable to eat orally, nutritional support can be provided through enteral or parenteral nutrition to enhance their immunity and promote wound healing.
Correcting anemia and hypoproteinemia: Infection may cause anemia and hypoproteinemia, affecting the patient’s recovery. Corrections can be made through methods such as infusing concentrated red blood cells and supplementing human albumin to enhance the patient’s blood oxygen carrying capacity and plasma colloid osmotic pressure, and improve the overall condition.
Local treatment
Wound treatment
Debridement: Thoroughly removing necrotic tissue, pus and foreign substances from the wound is the key to treating infection. During the debridement process, operate carefully to avoid damaging normal tissues and blood vessels. For superficial wound infections, debridement can be performed directly. For deep infections, it may be necessary to perform an expansion surgery in the operating room to fully expose the infected area and remove all infected tissues.
Drainage: After debridement, a suitable drainage tube or strip should be placed inside the wound to fully drain the exudate and pus within the wound, prevent the formation of effusion, and promote wound healing. The drainage tube should be kept unobstructed. Regularly observe the color, nature and volume of the drainage fluid, and replace the drainage tube in a timely manner as needed.
Dressing change: After the operation, regular dressing changes should be carried out on the wound to keep it clean and dry. When changing dressings, strictly follow the aseptic operation principle and select the appropriate dressing based on the healing condition of the wound. For wounds with severe infections, dressings containing antibiotics, such as silver ion dressings, can be used to inhibit bacterial growth.
Management of infected bone plates
Preservation of the bone plate: If the infection is mild, the bone plate is fixed stably, and the infection is controlled after active anti-infection treatment, preservation of the bone plate can be considered. However, during the period of bone plate preservation, the wound condition and the patient’s systemic symptoms should be closely observed to prevent recurrence of infection.
Removal of bone plates: For patients with severe infection, loose bone plates, or those whose infection cannot be controlled after long-term anti-infection treatment, bone plates need to be removed in a timely manner. After the bone plate is removed, a thorough debridement of the fracture site should be carried out, and whether re-fixation is necessary should be determined based on the healing condition of the fracture. If there is sufficient callus formation at the fracture end, an external fixator can be used for fixation. If the fracture end is unstable, other internal fixation methods, such as intramedullary nails, can be considered.
Physical therapy
Infrared irradiation: Infrared irradiation can promote local blood circulation, enhance the metabolic capacity of tissues, and facilitate the absorption and dissipation of inflammation. After changing the dressing on the wound, an infrared lamp can be used to irradiate the wound. Each irradiation session should last for 20 to 30 minutes, and it should be done 1 to 2 times a day. When irradiating, it is important to maintain an appropriate distance to avoid scalding the skin.
Ultrasound therapy: Ultrasound therapy can generate mechanical vibrations and thermal effects, which can promote cell metabolism, enhance the phagocytic function of white blood cells, and help eliminate bacteria and necrotic tissues within the wound. Appropriate ultrasonic treatment parameters can be selected based on the condition of the wound. During the treatment, attention should be paid to the movement speed and pressure of the treatment head to avoid causing damage to the wound.
Rehabilitation therapy
Functional exercise: When the infection is under control and the wound heals well, patients should be guided to perform appropriate functional exercises. Functional exercise should be carried out step by step, gradually transitioning from passive movement to active movement, and the range and intensity of activities should be gradually increased. For instance, for patients with lower limb fractures, one can first perform flexion and extension exercises of the ankle joint, then gradually move the knee and hip joints, and finally carry out weight-bearing training for the lower limbs.
Psychological support: Infection after bone plate fixation can cause significant psychological pressure to patients, leading to emotions such as anxiety and depression. Medical staff should pay attention to the psychological state of patients, provide timely psychological support and counseling, help patients build confidence in defeating the disease, and actively cooperate with the treatment.