One-stage revision for postoperative infection following internal fixation of hip fractures: a report of three cases

Postoperative infection following internal fixation of hip fractures is a rare but severe complication that can significantly impact patient outcomes. Conventional treatment typically involves a two-stage revision approach. This study investigates the efficacy of a one-stage revision procedure for managing infections after internal fixation of hip fractures, based on three clinical cases (one femoral neck fracture and two intertrochanteric fractures) treated at our institution. The patients underwent one-stage revision surgery, which included comprehensive debridement and a 2-week course of vancomycin administered both intravenously and via joint cavity injection. Discharge was permitted when inflammatory markers had normalized, bacterial cultures returned negative, and the patients' conditions were stabilized. Post-discharge, patients continued a 6-week course of oral rifampicin and ciprofloxacin. At the 1-year follow-up, none of the patients experienced pain or restricted range of motion, and all achieved Harris hip scores greater than 85. These results suggest that for infections following internal fixation of hip fractures, a one-stage revision, combined with thorough debridement and an adequate course of antibiotics (assuming a clear pathogen is identified), can effectively obviate the need for secondary surgeries, reduce healthcare costs, and minimize patient complications. This approach provides valuable insights and alternative strategies for managing postoperative hip fracture infections in clinical settings.