Implant‐Associated Osteomyelitis of Long Bones

Orthopaedic biofilm infections

“…In retrospect, they defined the following time intervals: early (≤2 weeks), delayed (between the 3 rd and 10 th week) and late (not defined but obviously ≥ 10 weeks). Over the last 30 years, this classification has been described more in detail and slightly adapted in 2006/2007, and in 2015 . The time interval between index surgery and onset of symptoms, together with the clinical presentation, help estimating the infection route and involved microorganisms (Table ), and hence, to guide empiric treatment after sampling.…”

“… Parts of this table has been published elsewhere . Sum adds to more than 100% because isolates within polymicrobial infections are also presented.…”

“…Removal of an infected intramedullary nail should always be followed by reaming of the diaphysis and over‐drilling of the locking screw holes. It is also essential to inspect the surgical field, and remove any dead bone or compromised soft‐tissue . Thereafter, antimicrobial therapy can be often stopped in a short while (i.e.…”

“…From an epidemiological point of view, the fraction of chronic osteomyelitis is steadily decreasing, because the diagnostic and therapeutic management of acute osteomyelitis improved. In addition, an appropriate combined surgical and antibiotic management of implant‐associated infection ameliorated during the last decades . The most frequent types of chronic osteomyelitis are summarized in Table .…”

Use of contemporary biomaterials in chronic osteomyelitis treatment: Clinical lessons learned and literature review

“…Obviously, meticulous culture specimens have to be taken to know the causative germ (and this is evidently applicable for Cierny II–IV cases too) and adapt adjuvant systemic antibiotic therapy or antibiotics administered in graft or other biomaterials. For this, the authors adhere to the “Oxford protocol” which consists of separate instruments for each sample, no‐touch technique, a minimum of three samples and no suction until samples are taken 21,23,24 . After mechanical debridement, a thorough wash‐out of the canal is performed and importantly in all osteomyelitis treatment: management of dead space, meaning the endomedullary canal has to be filled/obliterated to prevent formation of residual hematoma.…”