Evidence map›Paper›PMID 29725735›Full record

ArticleInternational orthopaedics2019

Treatment of infection following intramedullary nailing of tibial shaft fractures-results of the ORS/ISFR expert group survey.

Cyril Mauffrey, David J Hak, Peter Giannoudis, Volker Alt, Christoph Nau, Ingo Marzi, Peter Augat, J K Oh, Johannes Frank, Andreas Mavrogenis and 6 more

Abstract read
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In one paragraph

Article in International orthopaedics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.8field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 11 citations in OpenAlex.

  1. Intramedullary application of local antibiotic bullets for the treatment of long bone fracture related infection.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 1 institution in 1 country.

Cyril MauffreyDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA. Cyril.mauffrey@dhha.org.ORCID http://orcid.org/0000-0003-2132-3418
David J HakDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Peter GiannoudisDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Volker AltDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Christoph NauDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Ingo MarziDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Peter AugatDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
J K OhDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Johannes FrankDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Andreas MavrogenisDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Xavier FlecherDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Jean-Noel ArgensonDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Ashok GavaskarDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
David RojasDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Yehia H BedeirDepartment of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
From the ORS/ISFR expert group on Tibial bone defects
Denver Health Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe lack of universally accepted treatment principles and protocols to manage infected intramedullary (IM) nails following tibial fractures continues to challenge us, eliciting a demand for clear guidelines. Our response to this problem was to create an ORS/ISFR taskforce to identify potential solutions and trends based on published evidence and practices globally. MATERIALS AND

methodsA questionnaire of reported treatment methods was created based on a published meta-analysis on the topic. Treatment methods were divided in two groups: A (retained nail) and B (nail removed). Experts scored the questionnaire items on a scale of 1-4 twice, before and after revealing the success rates for each stage of infection. Inter- and intra-observer variability analysis among experts' personal scores and between experts' scores was performed. An agreement mean and correlation degree between experts' scores was calculated. Finally, a success rate report between groups was performed.

resultsExperts underestimated success rate of an individual treatment method compared to published data. The mean difference between experts' scores and published results was + 26.3 ± 46 percentage points. Inter-observer agreement mean was poor (< 0.2) for both rounds. Intra-observer agreement mean across different treatment methods showed a wide variability (18.3 to 64.8%). Experts agree more with published results for nail removal on stage 2 and 3 infections.

conclusionsExperts' and published data strongly agree to retain the implant for stage 1 infections. A more aggressive approach (nail removal) favoured for infection stages 2 and 3. However, literature supports both treatment strategies. EVIDENCE: Clinical Question.

Indexed as

CellulitisFracture Fixation, IntramedullaryHealth Care SurveysHumansOsteomyelitisSurgical Wound InfectionTibial FracturesTreatment OutcomeIntramedullary nailingNonunion tibiaSurvey on nonunionTibia fracturesTibia infectionTreatment algorithm

Identifiers

PMID29725735
OpenAlexW2801168653

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.