Treatment of early infection after fracture internal fixation by water jet debridement combined with negative pressure wound therapy

Objective To evaluate the effectiveness of water jet debridement combined with negative pressure wound therapy (NPWT) for the treatment of early infection after fracture internal fixation. Methods The study cohort included 6 men and one woman with an average age of 43.6 years (range, from 36 to 58 years) who had presented with early infection after fracture internal fixation from October 2013 to March 2015. All the patients sustained closed fractures initially. The wound debridement was done within 3 to 5 days after the infection was confirmed. The length and depth of an incision was determined by the methylene staining range. Water jet was used to eliminate the dying tissues thoroughly from a shallower layer to a deeper layer while the internal fixator was retained. The wound was closed by full thickness sutures in a sparse fashion for drainage. Sensitive antibiotics were systematically administered for all the patients. The NPWT device was kept for 5 days. Results All the wounds healed uneventfully after an average of 18 days (range, from 10 to 25 days). The mean follow-up time was 12 months (range, from 8 to 24 months). No antibiotics were used during follow-up. There were no local or systematical symptoms like new sinus, broken wound or fever. Bony callus formed at the fracture sites after an average of 4.3 months (range, from 2.5 to 8.0 months) and no fracture nonunion happened. All the fractures healed after an average of 10.1 months (range, from 5.5 to 16.0 months). All the patients were satisfied with their treatment outcomes. Conclusion Since water jet provides simple, rapid and radical debridement while NPWT simplifies operative procedures and promotes wound healing, combination of the two can be an effective treatment for early infection after fracture internal fixation. Key words: Fracture fixation; Infection; Drainage; Water jet