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.
