Osteomyelitis Following Distal Femur Fractures in Adults: A Systematic Review of Reported Incidence.

Medical (ORTHOPEDIC TRAUMA SURGERY )

Background: Distal femur fractures occur in between 3 – 6 % of femur fractures and also account for less than 1% of all fractures. Despite being relatively uncommon, it presents a major challenge especially considering the risk of complications. Osteomyelitis is one of the complications with varied burden across different regions. However, there is paucity of synthesized evidence on the burden of osteomyelitis. The purpose of this study was to review was the incidence or proportion of osteomyelitis following distal femur fracture treatment. Methods: This was a systematic review conducted based on the PRISMA guidelines. The studies that were included in the study were published between January 2000 to present through searches in PubMed, Embase and Google scholar. The studies that were included in this review included randomized control trials (RCTs), cohort studies or case series on adult distal femur fractures reporting postoperative osteomyelitis or deep infection rates. Further we also included studies that were written in English-language full text availability. However, case reports, reviews, editorials, pediatric or periprosthetic fractures, and studies without infection data were excluded. A narrative synthesis of the data was performed, and the risk of bias was evaluated. Results: A total of 99 studies were identified with 11 meeting the study inclusion criteria and thus were included in the study. The incidence rate of osteomyelitis varied significantly from 0.65% to 21% with higher incidence being reported among those with open fractures, male patients as well as those having underlying comorbidities. The studies included in this review were evaluated based on the Newcastle Ottawa Scale (NOS) and they ranged between 4 – 8 showing moderate quality and potential risk to bias mainly due to most of them being retrospective studies and limited follow up periods hence unable to conclusively document risk of osteomyelitis with increasing time after management. Conclusion: Osteomyelitis incidence rate varies across different regions with literature showing that the incidence is higher among those presenting with open fractures, male and those presenting with comorbidities. However, the varying study designs and follow up period limit the overall focus on the extent of the existing burden. Thus, there is need for standardized definitions with key focus on follow up period of focus to help quantify the burden and develop better targeted interventions.

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