Incidence and risk factors of surgical site infection in ruminant species following internal fixation for orthopedic injury: 81 cases (2010-2023).
Authors: Barton Charlotte K, Lozier Joseph W, Merkatoris Paul T, Jordan Brianna, McCormack John Ortega, Vanhoy Grace, Look Brayden, Nottle Bridget
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Surgical Site Infection Risk in Ruminant Orthopedic Surgery Researchers analysed 81 ruminants treated surgically for orthopedic fractures across five veterinary teaching hospitals over 13 years to identify which animals were most vulnerable to developing surgical site infections (SSI) following internal fixation. Surgical site infection occurred in 17.3% of cases, with 92.6% overall survival to discharge, though notably this dropped to 85.7% in animals that developed infection compared with 94% in those that remained infection-free. Two key risk factors emerged: fractures distal to the carpus or tarsus significantly increased SSI likelihood, as did prolonged postoperative antimicrobial administration—a somewhat counterintuitive finding that warrants further investigation into whether extended antibiotic courses may reflect underlying complications or altered wound healing. The choice of implant also mattered; intramedullary pins were associated with reduced survival rates, suggesting plate or screw fixation may be preferable in this species. With SSI rates comparable to horses and camelids, the findings support continued use of internal fixation in ruminant fracture management, though practitioners should exercise caution with distal limb injuries, reconsider the duration of postoperative antibiotic protocols, and consider implant selection carefully when survival outcomes are critical.
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Practical Takeaways
- •Internal fixation in ruminants is a viable option with good survival outcomes (92.6%), though SSI occurs in ~1 in 6 cases—comparable to other large animal species.
- •Distal limb fractures (below carpus/tarsus) carry higher infection risk; consider this when planning treatment and monitoring post-operatively.
- •Prolonged antibiotic courses may paradoxically increase SSI risk—review prophylaxis duration protocols and consider shorter, targeted courses based on this finding.
Key Findings
- •Surgical site infection incidence was 17.3% (14/81 cases) in ruminants following internal fixation, comparable to horses and camelids.
- •Prolonged antimicrobial use was associated with increased SSI risk (p=0.004), despite being intended to prevent infection.
- •Fractures distal to tarsus/carpus carried significantly higher SSI risk (p=0.04) compared to proximal fractures.
- •Overall survival to discharge was 92.6% (75/81), with intramedullary pins associated with reduced survival likelihood (p=0.008).