SynthesisArchives of orthopaedic and trauma surgery2024
Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients.
Synthesis in Archives of orthopaedic and trauma surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 11 citations in OpenAlex.
- Case report:JSES reviews, reports, and techniques · 2026Article
- Postoperative Antibiotic Duration and Treatment Failure After Aseptic Revision Arthroplasty With a Single Unexpected Positive Culture: A Retrospective Cohort Study.Orthopaedic surgery · 2026Article
- [One-stage debridement and internal fixation exchange combined with continuous local antibiotic irrigation in treatment of fracture-related infection].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2026Article
- [Nonunion: cause before treatment : From time-based definition to cause-directed treatment].Unfallchirurgie (Heidelberg, Germany) · 2026Article
- [One- or two-stage approach after osteosynthesis failure in proximal femur fracture-a narrative review].Orthopadie (Heidelberg, Germany) · 2026Review
- Microbiology, risk factors, and clinical outcomes of low-grade infection in long-bone diaphyseal non-union after open fracture.International orthopaedics · 2026Article
- Fracture nonunions.OTA international : the open access journal of orthopaedic trauma · 2025Article
- Article
- Systematic investigation and comparison of diagnostic methods in implant-related infections and infectious non-unions in trauma surgery- results of a prospective study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Membrane Filtration of Sonication Fluid-A Promising Adjunctive Method for the Diagnosis of Low-Grade Infection in Presumed Aseptic Nonunion.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2025Article
- Single- versus two-stage revision surgery in the case of fracture-related infection: a systematic review.Journal of bone and joint infection · 2025Review
- Long-Term Outcomes Following Single-Stage Reamed Intramedullary Exchange Nailing in Apparently Aseptic Femoral Shaft Nonunion with Unsuspected Proof of Bacteria.Journal of clinical medicine · 2024Article
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn pre-operatively presumed aseptic nonunions, the definitive diagnosis of infection relies on intraoperative cultures. Our primary objective was to determine (1) the rate of surprise positive intraoperative cultures in presumed aseptic long-bone nonunion (surprise positive culture nonunion), and (2) the rate of surprise positive cultures that represent infection vs. contamination. Secondary objectives were to determine the healing and secondary surgery rates and to identify cultured micro-organisms. MATERIALS AND
methodsWe performed a systematic literature search of PubMed, Embase and Cochrane Libraries from 1980 until December 2021. We included studies reporting on ≥ 10 adult patients with a presumed aseptic long-bone nonunion, treated with a single-stage surgical protocol, of which intraoperative cultures were reported. We performed a meta-analysis for: (1) the rates of surprise positive culture nonunion, surprise infected nonunion, and contaminated culture nonunion, and (2) healing and (3) secondary surgery rates for each culture result. Risk of bias was assessed using the QUADAS-2 tool.
results21 studies with 2,397 patients with a presumed aseptic nonunion were included. The rate of surprise positive culture nonunion was 16% (95%CI: 10-22%), of surprise infected nonunion 10% (95%CI: 5-16%), and of contaminated culture nonunion 3% (95%CI: 1-5%). The secondary surgery rate for surprise positive culture nonunion was 22% (95%CI: 9-38%), for surprise infected nonunion 14% (95%CI 6-22%), for contaminated culture nonunion 4% (95%CI: 0-19%), and for negative culture nonunion 6% (95CI: 1-13%). The final healing rate was 98% to 100% for all culture results. Coagulase-negative staphylococci accounted for 59% of cultured micro-organisms.
conclusionThese results suggest that surprise positive cultures play a role in the clinical course of a nonunion and that culturing is important in determining the etiology of nonunion, even if the pre-operative suspicion for infection is low. High healing rates can be achieved in presumed aseptic nonunions, regardless of the definitive intraoperative culture result.
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