[One-stage debridement and internal fixation exchange combined with continuous local antibiotic irrigation in treatment of fracture-related infection].

OBJECTIVE: To investigate the effectiveness and application value of one-stage debridement, internal fixation exchange combined with continuous local antibiotic irrigation in the treatment of fracture-related infection (FRI).

METHODS: The clinical data of 11 FRI patients who met the selection criteria between January 2023 and January 2025 were retrospectively analyzed. There were 7 males and 4 females, aged 39-82 years (mean, 58.6 years). The fracture sites included humerus in 3 cases, femur in 4 cases, and tibia in 4 cases. The initial fixation methods were plate fixation in 6 cases and intramedullary nailing in 5 cases. The time from fracture surgery to infection onset ranged from 17 to 630 days (mean, 121 days). All patients underwent one-stage thorough debridement, internal fixation exchange, and continuous local antibiotic irrigation with alternating vancomycin and meropenem. The operation time, intraoperative blood loss, drainage tube indwelling time, and hospital stay were recorded; infection control and fracture healing were evaluated; the Hospital for Special Surgery (HSS) score was used to assess hip and knee joint function, and the Mayo Elbow Performance Score (MEPS) was used to evaluate elbow joint function.

RESULTS: All 11 patients completed the operation successfully. The operation time ranged from 83 to 150 minutes (mean, 113.0 minutes); the intraoperative blood loss ranged from 200 to 810 mL (mean, 364.5 mL); the drainage tube indwelling time ranged from 11 to 15 days (mean, 12.9 days); and the hospital stay ranged from 15 to 27 days (mean, 21.5 days). All patients were followed up 12-29 months (mean, 20.1 months). During the follow-up, no infection recurrence was observed; fracture healing was achieved at last follow-up; no severe antibiotic-related adverse reactions or internal fixation failure occurred. At last follow-up, among the 4 patients undergoing tibial internal fixation revision, the knee HSS scores were excellent in 2, good in 1, and poor in 1; among the 3 patients undergoing humeral internal fixation revision, the elbow MEPS scores were excellent in 3; among the 4 patients undergoing femoral internal fixation revision, the hip HSS scores were excellent in 2 and good in 2.

CONCLUSION: For strictly selected FRI patients, one-stage thorough debridement, internal fixation exchange combined with continuous local antibiotic irrigation can effectively control infection while restoring bone stability, reducing complications associated with staged surgery, demonstrating favorable clinical efficacy and safety.