Prevalence of infection and associated factors after intramedullary nailing in African countries with the Surgical Implant Generation Network program: A systematic review and meta-analysis of available evidence

Abstract

Background: Infections following orthopedic procedures, such as implant insertion, are common and pose significant burdens globally. Comprehensive evidence of its prevalence and the influencing factors is crucial for developing effective infection prevention strategies across regions. Objective: To assess the prevalence of infection and associated factors after Surgical Implant Generation Network nailing in African countries with the Surgical Implant Generation Network program. Method: A comprehensive search was performed across multiple databases, including PubMed, Global Index Medicus, Scopus, Embase, Science Direct, Hinari, and African Journals Online, complemented by a search of Google Scholar. After data extraction, the data were exported to STATA 17 statistical software for analysis. The pooled prevalence of infection was estimated using a random effects model. The level of heterogeneity was assessed using the I ² test, while publication bias was evaluated through a funnel plot and Egger’s and Begg’s tests. Results: This meta-analysis included 23 full-text studies involving a total of 4266 patients treated with Surgical Implant Generation Network intramedullary nailing for long bone fractures. The pooled prevalence of infection was 5.69% (95% CI: 4.55%–6.83%), with a moderate level of heterogeneity ( I ² = 57.86%, p < 0.001). The review also identified significant predictors of infection, including open fracture type, complex fracture patterns, surgery performed within 15 days of injury, the presence of a prophylactic drain, female gender, and procedures conducted by junior surgeons. Conclusion: This meta-analysis revealed a relatively high infection prevalence in patients who underwent Surgical Implant Generation Network nailing for fractures. Infection risk was significantly higher in cases involving open or complex fractures, early surgical intervention, use of prophylactic drains, female patients, and procedures conducted by less-experienced surgeons. To mitigate this burden, clinical efforts should focus on optimizing the timing of surgery, avoiding unnecessary drain placement, strengthening supervision for junior surgeons, and prioritizing enhanced intraoperative and postoperative care for high-risk fracture types.