The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study
Abstract Background Septic and aseptic nonunion require different therapeutic strategies. However, differential diagnosis is challenging, as low-grade infections and biofilm-bound bacteria often remain undetected. Therefore, the examination of biofilm on implants by sonication and the evaluation of...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2023-06-01
|
| Series: | Journal of Orthopaedics and Traumatology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s10195-023-00708-4 |
| _version_ | 1797801300097761280 |
|---|---|
| author | Katharina Trenkwalder Sandra Erichsen Ferdinand Weisemann Peter Augat Matthias Militz Christian von Rüden Tobias Hentschel SAND Research Group Simon Hackl |
| author_facet | Katharina Trenkwalder Sandra Erichsen Ferdinand Weisemann Peter Augat Matthias Militz Christian von Rüden Tobias Hentschel SAND Research Group Simon Hackl |
| author_sort | Katharina Trenkwalder |
| collection | DOAJ |
| description | Abstract Background Septic and aseptic nonunion require different therapeutic strategies. However, differential diagnosis is challenging, as low-grade infections and biofilm-bound bacteria often remain undetected. Therefore, the examination of biofilm on implants by sonication and the evaluation of its value for differentiating between femoral or tibial shaft septic and aseptic nonunion in comparison to tissue culture and histopathology was the focus of this study. Materials and methods Osteosynthesis material for sonication and tissue samples for long-term culture and histopathologic examination from 53 patients with aseptic nonunion, 42 with septic nonunion and 32 with regular healed fractures were obtained during surgery. Sonication fluid was concentrated by membrane filtration and colony-forming units (CFU) were quantified after aerobic and anaerobic incubation. CFU cut-off values for differentiating between septic and aseptic nonunion or regular healers were determined by receiver operating characteristic analysis. The performances of the different diagnostic methods were calculated using cross-tabulation. Results The cut-off value for differentiating between septic and aseptic nonunion was ≥ 13.6 CFU/10 ml sonication fluid. With a sensitivity of 52% and a specificity of 93%, the diagnostic performance of membrane filtration was lower than that of tissue culture (69%, 96%) but higher than that of histopathology (14%, 87%). Considering two criteria for infection diagnosis, the sensitivity was similar for one tissue culture with the same pathogen in broth-cultured sonication fluid and two positive tissue cultures (55%). The combination of tissue culture and membrane-filtrated sonication fluid had a sensitivity of 50%, which increased up to 62% when using a lower CFU cut-off determined from regular healers. Furthermore, membrane filtration demonstrated a significantly higher polymicrobial detection rate compared to tissue culture and sonication fluid broth culture. Conclusions Our findings support a multimodal approach for the differential diagnosis of nonunion, with sonication demonstrating substantial usefulness. Level of Evidence: Level 2 Trial registration DRKS00014657 (date of registration: 2018/04/26) |
| first_indexed | 2024-03-13T04:48:21Z |
| format | Article |
| id | doaj.art-4c2cfb8df1ed489f8bd8df3a0f1fbbbe |
| institution | Directory Open Access Journal |
| issn | 1590-9999 |
| language | English |
| last_indexed | 2024-03-13T04:48:21Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj.art-4c2cfb8df1ed489f8bd8df3a0f1fbbbe2023-06-18T11:21:53ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992023-06-0124111210.1186/s10195-023-00708-4The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical studyKatharina Trenkwalder0Sandra Erichsen1Ferdinand Weisemann2Peter Augat3Matthias Militz4Christian von Rüden5Tobias Hentschel6SAND Research GroupSimon Hackl7Institute for Biomechanics, BG Unfallklinik MurnauInstitute for Biomechanics, BG Unfallklinik MurnauDepartment of Trauma Surgery, BG Unfallklinik MurnauInstitute for Biomechanics, BG Unfallklinik MurnauDepartment of Trauma Surgery, BG Unfallklinik MurnauInstitute for Biomechanics, Paracelsus Medical UniversityDepartment of Trauma Surgery, BG Unfallklinik MurnauInstitute for Biomechanics, Paracelsus Medical UniversityAbstract Background Septic and aseptic nonunion require different therapeutic strategies. However, differential diagnosis is challenging, as low-grade infections and biofilm-bound bacteria often remain undetected. Therefore, the examination of biofilm on implants by sonication and the evaluation of its value for differentiating between femoral or tibial shaft septic and aseptic nonunion in comparison to tissue culture and histopathology was the focus of this study. Materials and methods Osteosynthesis material for sonication and tissue samples for long-term culture and histopathologic examination from 53 patients with aseptic nonunion, 42 with septic nonunion and 32 with regular healed fractures were obtained during surgery. Sonication fluid was concentrated by membrane filtration and colony-forming units (CFU) were quantified after aerobic and anaerobic incubation. CFU cut-off values for differentiating between septic and aseptic nonunion or regular healers were determined by receiver operating characteristic analysis. The performances of the different diagnostic methods were calculated using cross-tabulation. Results The cut-off value for differentiating between septic and aseptic nonunion was ≥ 13.6 CFU/10 ml sonication fluid. With a sensitivity of 52% and a specificity of 93%, the diagnostic performance of membrane filtration was lower than that of tissue culture (69%, 96%) but higher than that of histopathology (14%, 87%). Considering two criteria for infection diagnosis, the sensitivity was similar for one tissue culture with the same pathogen in broth-cultured sonication fluid and two positive tissue cultures (55%). The combination of tissue culture and membrane-filtrated sonication fluid had a sensitivity of 50%, which increased up to 62% when using a lower CFU cut-off determined from regular healers. Furthermore, membrane filtration demonstrated a significantly higher polymicrobial detection rate compared to tissue culture and sonication fluid broth culture. Conclusions Our findings support a multimodal approach for the differential diagnosis of nonunion, with sonication demonstrating substantial usefulness. Level of Evidence: Level 2 Trial registration DRKS00014657 (date of registration: 2018/04/26)https://doi.org/10.1186/s10195-023-00708-4Septic nonunionAseptic nonunionFracture-related infectionLow-grade infectionSonicationMembrane filtration |
| spellingShingle | Katharina Trenkwalder Sandra Erichsen Ferdinand Weisemann Peter Augat Matthias Militz Christian von Rüden Tobias Hentschel SAND Research Group Simon Hackl The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study Journal of Orthopaedics and Traumatology Septic nonunion Aseptic nonunion Fracture-related infection Low-grade infection Sonication Membrane filtration |
| title | The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study |
| title_full | The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study |
| title_fullStr | The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study |
| title_full_unstemmed | The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study |
| title_short | The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study |
| title_sort | value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology a prospective multicenter clinical study |
| topic | Septic nonunion Aseptic nonunion Fracture-related infection Low-grade infection Sonication Membrane filtration |
| url | https://doi.org/10.1186/s10195-023-00708-4 |
| work_keys_str_mv | AT katharinatrenkwalder thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT sandraerichsen thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT ferdinandweisemann thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT peteraugat thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT matthiasmilitz thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT christianvonruden thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT tobiashentschel thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT sandresearchgroup thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT simonhackl thevalueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT katharinatrenkwalder valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT sandraerichsen valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT ferdinandweisemann valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT peteraugat valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT matthiasmilitz valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT christianvonruden valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT tobiashentschel valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT sandresearchgroup valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy AT simonhackl valueofsonicationinthedifferentialdiagnosisofsepticandasepticfemoralandtibialshaftnonunionincomparisontoconventionaltissuecultureandhistopathologyaprospectivemulticenterclinicalstudy |