Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

Previous studies have shown that sonication fluid cultures from removed orthopedic devices improved the microbiological diag-nosis of orthopedic implant-associated infections; however, few of these investigations have applied sonication to the removed fracture fixation devices to evaluate its utility for the diagnosis of osteosynthesis-associated infection (OAI). We compared soni-cation fluid to conventional tissue cultures from 180 subjects with different sizes of plates and screws (n 156), spinal implants (n 26), and intramedullary nails (n 3), of whom 125 and 55 subjects had OAI and noninfected osteosynthesis (NIO), respec-tively. The sensitivity for detecting OAI was 90.4 % for sonication fluid culture and 56.8 % for periprosthetic tissue cultures (P< 0.05), and the specificities were 90.9 % and 96.4%, respectively. Sonication fluid culture detected more pathogens than peri-im-plant tissue culture (113 versus 71; P< 0.001), while polymicrobial infections were diagnosed by sonication fluid cultures and tissue cultures in 20.8 % and 8 % (P< 0.001), respectively. Microbiological diagnosis was achieved exclusively by sonication fluid cultures for 47 (90.4%) subjects, and among them, 18 (38.3%) had previously received antibiotics, whereas in five (9.6%) infected subjects, tissue culture was positive and the sonication fluid culture was negative. Among 39 (31.2%) OAI cases receiving antibi-otics, the identification of the organisms occurred in 38.5 % and 82.1 % of the tissue and sonication fluid cultures, respectively (P< 0.049). We demonstrated that sonication fluid culture from removed osteosyntheses has the potential for improving the microbiological diagnosis of OAI. Due to the increasing occurrence of trauma and injuries, par-ticularly those associated with road traffic accidents (1), sur