Fracture-related infection

Moriarty, T. Fintan; Metsemakers, Willem‐Jan; Morgenstern, Mario; Hofstee, Marloes I.; Vallejo, Amparo; Cassat, James E.; Wildemann, Britt; Depypere, Maarten; Schwarz, Edward M.; Richards, R. Geoff

doi:10.1038/s41572-022-00396-0

Cited by 56 publications

(37 citation statements)

References 177 publications

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“…2.). S. aureus possesses multiple mechanisms to colonize bone and is widely viewed as the predominant pathogen in FRI (Moriarty et al, 2022;Masters et al, 2022). Recent research on the time-dependent microbiological epidemiology of FRI has shown an important role for Enterobacterales in acute/early infection.…”

Section: Microbiological Epidemiologymentioning

confidence: 99%

Diagnosis of fracture-related infection in patients without clinical confirmatory criteria: an international retrospective cohort study

Vanvelk

Lieshout

Onsea

et al. 2023

J. Bone Joint Infect.

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Abstract. Background: fracture-related infection (FRI) remains a serious complication in orthopedic trauma. To standardize daily clinical practice, a consensus definition was established, based on confirmatory and suggestive criteria. In the presence of clinical confirmatory criteria, the diagnosis of an FRI is evident, and treatment can be started. However, if these criteria are absent, the decision to surgically collect deep tissue cultures can only be based on suggestive criteria. The primary study aim was to characterize the subpopulation of FRI patients presenting without clinical confirmatory criteria (fistula, sinus, wound breakdown, purulent wound drainage or presence of pus during surgery). The secondary aims were to describe the prevalence of the diagnostic criteria for FRI and present the microbiological characteristics, both for the entire FRI population. Methods: a multicenter, retrospective cohort study was performed, reporting the demographic, clinical and microbiological characteristics of 609 patients (with 613 fractures) who were treated for FRI based on the recommendations of a multidisciplinary team. Patients were divided in three groups, including the total population and two subgroups of patients presenting with or without clinical confirmatory criteria. Results: clinical and microbiological confirmatory criteria were present in 77 % and 87 % of the included fractures, respectively. Of patients, 23 % presented without clinical confirmatory criteria, and they mostly displayed one (31 %) or two (23 %) suggestive clinical criteria (redness, swelling, warmth, pain, fever, new-onset joint effusion, persisting/increasing/new-onset wound drainage). The prevalence of any suggestive clinical, radiological or laboratory criteria in this subgroup was 85 %, 55 % and 97 %, respectively. Most infections were monomicrobial (64 %) and caused by Staphylococcus aureus. Conclusion: clinical confirmatory criteria were absent in 23 % of the FRIs. In these cases, the decision to operatively collect deep tissue cultures was based on clinical, radiological and laboratory suggestive criteria. The combined use of these criteria should guide physicians in the management pathway of FRI. Further research is needed to provide guidelines on the decision to proceed with surgery when only these suggestive criteria are present.

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Section: Microbiological Epidemiologymentioning

confidence: 99%

Diagnosis of fracture-related infection in patients without clinical confirmatory criteria: an international retrospective cohort study

Vanvelk

Lieshout

Onsea

et al. 2023

J. Bone Joint Infect.

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“…Orthopaedic medical devices play a crucial role in restoring functionality to patients suffering from debilitating conditions, but their surgical implantation carries a risk of infection, with a profound impact for patients and healthcare providers [ 266 ]. Given the increasing patient life expectancy and anticipated increase in the number of orthopaedic implantation procedures that will be undertaken, orthopaedic device infection represents a salient problem for all stakeholders.…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Strategies to Mitigate and Treat Orthopaedic Device-Associated Infections

et al. 2022

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Orthopaedic device implants play a crucial role in restoring functionality to patients suffering from debilitating musculoskeletal diseases or to those who have experienced traumatic injury. However, the surgical implantation of these devices carries a risk of infection, which represents a significant burden for patients and healthcare providers. This review delineates the pathogenesis of orthopaedic implant infections and the challenges that arise due to biofilm formation and the implications for treatment. It focuses on research advancements in the development of next-generation orthopaedic medical devices to mitigate against implant-related infections. Key considerations impacting the development of devices, which must often perform multiple biological and mechanical roles, are delineated. We review technologies designed to exert spatial and temporal control over antimicrobial presentation and the use of antimicrobial surfaces with intrinsic antibacterial activity. A range of measures to control bio-interfacial interactions including approaches that modify implant surface chemistry or topography to reduce the capacity of bacteria to colonise the surface, form biofilms and cause infections at the device interface and surrounding tissues are also reviewed.

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“…Bone defects caused by fracture-related infection (FRI) remain challenging orthopaedic problems for surgeons [ 1 – 3 ]. Over the past decades, bone defects of the lower extremities have been successfully treated with several protocols, including the Ilizarov technique [ 4 ], the Masquelet technique [ 5 ], vascularized autogenous bone grafting [ 6 ], etc.…”

Section: Introductionmentioning

confidence: 99%

Bifocal versus trifocal bone transport for the management of tibial bone defects caused by fracture-related infection: a meta-analysis

Zhang

Maimaiti

et al. 2023

J Orthop Surg Res

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Background The purpose of this meta-analysis was to compare the efficacy and outcomes of bifocal bone transport (BFT) and trifocal bone transport (TFT) for the treatment of tibial bone defects caused by fracture-related infection (FRI). Methods The literature searches of Cochrane Library, Embase, Google Scholar databases, PubMed/Medline, and Web of Science for literature published up to September 20, 2022, were performed. The quality of the included studies was evaluated according to the MINORS scale. Patients were divided into the BFT group and the TFT group, depending on the site of the osteotomy. The demographic data, defect size (DS), external fixation time (EFT), external fixation index (EFI), bone and functional results, complications, and autologous bone grafting (ABG) were extracted and analyzed using the Review Manager software (version 5.3). Results Five studies included 484 patients with tibial bone defects treated by bone transport investigated in this meta-analysis, with a mean bone defect of 9.3 cm. There were statistical differences in DS (MD = − 2.38, 95% CI − 3.45 to − 1.32, P < 0.0001), EFT (MD = 103.44, 95% CI 60.11 to 146.77, P < 0.00001), and EFI (MD = 26.02, 95% CI 14.38 to 37.65, P < 0.00001) between BFT group and TFT group. There was no statistical difference in bone results (RR = 0.98, 95% CI 0.91 to 1.06, P = 0.67), functional results (RR = 0.94, 95% CI 0.82 to 1.07, P = 0.37), complications (OR = 1.57, 95% CI 0.59 to 4.14, P = 0.36), and ABG (RR = 1.2, 95% CI 0.78 to 1.84, P = 0.42) between two groups. Conclusions TFT was a feasible and practical method in the treatment of massive tibial bone defects caused by FRI to receive shorter EFT and satisfactory bone and functional results.

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Fracture-related infection

Cited by 56 publications

References 177 publications

Diagnosis of fracture-related infection in patients without clinical confirmatory criteria: an international retrospective cohort study

Diagnosis of fracture-related infection in patients without clinical confirmatory criteria: an international retrospective cohort study

Strategies to Mitigate and Treat Orthopaedic Device-Associated Infections

Bifocal versus trifocal bone transport for the management of tibial bone defects caused by fracture-related infection: a meta-analysis

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