Fracture‐Related Infection of the Long Bones

What Factors Affect Outcome in the Treatment of Fracture-Related Infection?

“…We included patients treated at three centers, in two countries, to give a broad representation of the range of treatments used in different healthcare settings. Most previous studies reported the results of a specific surgical treatment, such as debridement and implant retention [ 11 , 26 ], antibiotic-coated nailing [ 27 , 28 ], soft tissue reconstruction [ 20 , 21 ] or the use of local antibiotics [ 23 ]. Chadayammuri et al [ 29 ] reported on outcomes of 142 infected fractures, but this cohort was under-powered and could not show significant differences in many aspects of care.…”

“…The division of FRIs into ‘early’ (presenting within 2 weeks of fracture), ‘delayed’ (presenting 3–10 weeks after fracture) and ‘late’ (presenting after 10 weeks) has been advocated to aid decision making in surgery [ 10 , 11 ]. This view is based on the biofilm model of implant infection [ 12 ], where the maturation of the biofilm, over time, reduces bacterial susceptibility to systemic anti-microbials [ 13 , 14 ].…”

“…The use of DAIR, exchange of implants or conversion from internal to external fixation have all been studied separately, but there are few comparisons of the outcome of each strategy [ 8 , 11 , 16 , 17 , 18 ]. There is an agreement that fracture stability is essential in the prevention and treatment of FRIs [ 9 , 17 , 19 ].…”

“…Similarly, the restoration of the soft tissue envelope is recommended [8,18,20,21]. Antimicrobial therapy should be delivered systemically [22], but there is also increasing interest in local anti-microbial delivery in FRIs [9,11,14,23]. The recent guidance issued by the international FRI consensus group [24] highlighted that, although local antibiotics were established in the treatment of prosthetic joint infection, much less data are available on fracture-related infection.…”

Infecciones osteoarticulares Epidemiología, etiología y evolución clínica en un centro de referencia nacional

“…La infección se produce principalmente por la inoculación directa de microorganismos durante el procedimiento quirúrgico o la llegada desde un sitio cercano o por vía hematógena. En cuanto a la etiología, predominan las bacterias, 50-60% cocos gram positivos (Staphylococcus aureus, Staphylococcus coagulasa negativo, Streptococcus sp y Enterococcus sp), 30% bacilos gram negativos (Klebsiella penumoniae, Enterobacter sp, E. Coli, etc), finalmente anaerobios y hongos representan < 5% [6][7][8] . El tratamiento se base en 2 pilares fundamentales, antimicrobianos por períodos prolongados más el drenaje quirúrgico de colecciones, tejidos necróticos y retiro de implantes en procesos crónicas 3,[9][10] .…”