The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study.
J Orthop Traumatol
; 24(1): 25, 2023 Jun 12.
Article
in En
| MEDLINE
| ID: mdl-37308767
ABSTRACT
BACKGROUND:
Septic and aseptic nonunion require different therapeutic strategies. However, differential diagnosis is challenging, as low-grade infections and biofilm-bound bacteria often remain undetected. Therefore, the examination of biofilm on implants by sonication and the evaluation of its value for differentiating between femoral or tibial shaft septic and aseptic nonunion in comparison to tissue culture and histopathology was the focus of this study. MATERIALS ANDMETHODS:
Osteosynthesis material for sonication and tissue samples for long-term culture and histopathologic examination from 53 patients with aseptic nonunion, 42 with septic nonunion and 32 with regular healed fractures were obtained during surgery. Sonication fluid was concentrated by membrane filtration and colony-forming units (CFU) were quantified after aerobic and anaerobic incubation. CFU cut-off values for differentiating between septic and aseptic nonunion or regular healers were determined by receiver operating characteristic analysis. The performances of the different diagnostic methods were calculated using cross-tabulation.RESULTS:
The cut-off value for differentiating between septic and aseptic nonunion was ≥ 13.6 CFU/10 ml sonication fluid. With a sensitivity of 52% and a specificity of 93%, the diagnostic performance of membrane filtration was lower than that of tissue culture (69%, 96%) but higher than that of histopathology (14%, 87%). Considering two criteria for infection diagnosis, the sensitivity was similar for one tissue culture with the same pathogen in broth-cultured sonication fluid and two positive tissue cultures (55%). The combination of tissue culture and membrane-filtrated sonication fluid had a sensitivity of 50%, which increased up to 62% when using a lower CFU cut-off determined from regular healers. Furthermore, membrane filtration demonstrated a significantly higher polymicrobial detection rate compared to tissue culture and sonication fluid broth culture.CONCLUSIONS:
Our findings support a multimodal approach for the differential diagnosis of nonunion, with sonication demonstrating substantial usefulness. LEVEL OF EVIDENCE Level 2 Trial registration DRKS00014657 (date of registration 2018/04/26).Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Sonication
/
Femur
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Observational_studies
Limits:
Humans
Language:
En
Journal:
J Orthop Traumatol
Journal subject:
ORTOPEDIA
/
TRAUMATOLOGIA
Year:
2023
Document type:
Article
Affiliation country:
Germany
Publication country:
IT
/
ITALIA
/
ITALY
/
ITÁLIA