Incidence and risk factors of fracture-related infection after SIGN nailing of open femoral fractures in Ethiopia

Abstract

Fracture-related infection is one of the most serious complications following open fracture management. Despite its preventable complications, Fracture-related infections continue to threaten public health with significant impacts on human and financial resources. The number of patients with open femur fractures increased in our hospital due to the war in the northern part of Ethiopia, but there was no study. This study aimed to assess the incidence of Fracture-related infection and its associated factors after intramedullary nailing of an open femur fracture using a Surgical Implant Generation Network nail. A cross-sectional study was done on adult patients admitted with a diagnosis of open femur fracture and treated by intramedullary nailing using Surgical Implant Generation Network nail, fulfilling the inclusion criteria at the Department of Orthopedic and Trauma Surgery, Tibebe Ghion Specialized Hospital from January 1/2022 to July 1/2024. The data were collected from the electronic data of the Surgical Implant Generation Network online database and patient charts from hospital records. Data was entered and analyzed using SPSS 27. A total of 115 of 125 patients (92.0%) were included. Among them, 100 were males, and 15 were females with a mean age of 29.83 ± 10 years. The estimated incidence of Fracture-related infection was 12.2%. Patients who have received antibiotics after 6 h of injury are 4 times more likely to develop fracture-related infection compared to those who have received before 6 h of injury (AOR = 4.0; 95%CI 1.0 -15.3) and those who had one debridement were 4 times more likely to develop Fracture-related infection compared to those who had more than one debridement (AOR = 3.9; 95%CI 1.1–14.0). The incidence of fracture-related infection following SIGN intramedullary nailing of open femur fractures was 12.2% in this study. Delayed administration of antibiotics beyond six hours after injury and inadequate surgical debridement were significantly associated with increased infection risk. Early antibiotic administration and adequate wound debridement remain critical strategies for reducing fracture-related infections in open femur fractures.