Infection after fracture fixation: Current surgical and microbiological concepts

Abstract

One of the most challenging complications in trauma surgery is infection after fracture fixation (IAFF). IAFF may result in permanent functional loss or even amputation of the affected limb in patients who may otherwise be expected to achieve complete, uneventful healing. Over the past decades, the problem of implant related bone infections has garnered increasing attention both in the clinical as well as preclinical arenas; however this has primarily been focused upon prosthetic joint infection (PJI), rather than on IAFF. Although IAFF shares many similarities with PJI, there are numerous critical differences in many facets including prevention, diagnosis and treatment. Admittedly, extrapolating data from PJI research to IAFF has been of value to the trauma surgeon, but we should also be aware of the unique challenges posed by IAFF that may not be accounted for in the PJI literature. This review summarizes the clinical approaches towards the diagnosis and treatment of IAFF with an emphasis on the unique aspects of fracture care that distinguish IAFF from PJI. Finally, recent developments in anti-infective technologies that may be particularly suitable or applicable for trauma patients in the future will be briefly discussed.

Influence of fracture stability on Staphylococcus epidermidis and Staphylococcus aureus infection in a murine femoral fracture model

“…In addition, purulent tissue was observed over the plate and osteolysis was observed around the screws, below the implant and at the osteotomy site. This also correlated with clinical observations, whereby S. aureus infection is associated with acute onset of symptoms (Metsemakers et al, 2016).…”

“…www.ecmjournal.org of infection. This closely matched the typical clinical picture of S. epidermidis infection (Metsemakers et al, 2016;Schafer et al, 2008). Instead, animals infected with S. aureus exhibited greater weight loss, larger CFU counts in tissues and greater cell numbers in spleen and lymph node, suggesting the recruitment of lymphocytes and leukocytes, and overall more inflammation.…”

“…FRI is often associated with prolonged antibiotic treatment, repeated surgical debridement, implant removal, high healthcare costs and poor functional outcome for affected patients (Metsemakers et al, 2016;Willey and Karam, 2016). The prevalence of FRI ranges from 0.5-3 % for closed fractures, but can increase up to 30 % in open fractures (Metsemakers et al, 2016;Uckay et al, 2013).…”

“…FRI is often associated with prolonged antibiotic treatment, repeated surgical debridement, implant removal, high healthcare costs and poor functional outcome for affected patients (Metsemakers et al, 2016;Willey and Karam, 2016). The prevalence of FRI ranges from 0.5-3 % for closed fractures, but can increase up to 30 % in open fractures (Metsemakers et al, 2016;Uckay et al, 2013). Staphylococcus aureus (S. aureus) and the coagulase-negative staphylococci (CoNS), in particular Staphylococcus epidermidis (S. epidermidis), are the most prevalent species in FRI, accounting together for 50-75 % of all cases (Montanaro et al, 2011;Trampuz and Zimmerli, 2006).…”

Prevention of fracture-related infection: a multidisciplinary care package

“…The incidence of infection after internal fixation of closed fractures is reported to be 1-2% but can reach 30% in cases of open fractures [5][6][7]. As the consequences of such infection can be life-changing for the patient due to permanent functional loss or amputation of the affected limb, patient quality of life (QoL) and functional status also decrease [8][9][10].…”