Research Article

Prophylactic surgical drainage is associated with increased infection following intramedullary nailing of diaphyseal long bone fractures: A prospective cohort study in Nigeria

¹ Consultant Orthopaedic & Trauma Surgeon, Federal Medical Center, Orlu Road, Owerri, Imo State, Nigeria
² Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, 2550 23rd Street, Building 9, 3rd Floor, San Francisco, CA 94110, USA
³ Consultant Orthopaedic Surgeon, National Orthopaedic Hospital, Enugu, Abakpa junction Abakiliki Express Road, Enugu, P.M.B. 01294 Enugu State, Nigeria
⁴ Consultant Orthopaedic Surgeon, Federal Medical Center, Orlu Road, Owerri, Imo State, Nigeria
⁵ Consultant Orthopaedic Surgeon, University of Calabar Teaching Hospital, Court Rd, Duke Town, Calabar, Cross River State, Nigeria

^* Corresponding author: patrick.d.albright@gmail.com

Received: 21 January 2019
Accepted: 28 January 2020

Abstract

Introduction: Prophylactic surgical drains are commonly used in Nigeria following intramedullary nailing (IMN) of long bone diaphyseal fractures. However, evidence in the literature suggests that drains do not confer any benefit and predispose clean wounds to infection. This study compares outcomes between patients treated with and without prophylactic surgical drainage following diaphyseal long bone fractures treated with IMN. Methods: A prospective cohort study with randomization was conducted at a tertiary referral center in Enugu, Nigeria. Investigators included skeletally mature patients with diaphyseal long bone (femur, tibia, humerus) fractures treated with SIGN IMN. Patients followed-up at 5, 14, and 30 days post-operatively. The primary outcome was surgical site infection (SSI) rate. Secondary outcomes included post-operative pain at 6 and 12 h, need for blood transfusion, wound characteristics (swelling, ecchymosis, and gaping), need for dressing changes, and length of hospital stay. Results: Of the enrolled patients, 76 (96%) of 79 completed 30-day follow-up. SSI rate was associated with patients who received a prophylactic drain versus those who did not (23.7% vs. 10.5%, p = 0.007). There were no significant differences in transfusion need (p = 0.22), wound swelling (p = 0.74), wound ecchymosis (p = 1.00), wound gaping (p = 1.00), dressing change need (p = 0.31), post-operative pain at 6 h (p = 0.25) or 12 h (p = 0.57), or length of stay (p = 0.95). Discussion: Surgical drain placement following IMN of diaphyseal long bone fractures is associated with a significantly higher risk of SSI. Reducing surgical drain use following orthopaedic injuries in lower resource settings may translate to reduced infection rates.