Infection after fracture fixation

[摘要] Infection after fracture fixation (IAFF) in orthopaedic surgery is a dreaded complication, leading to non-union, loss of function, and even amputation. It is not only a source of morbidity and mortality,1 but it also brings an important socio-economic burden.2 The success rate in the treatment of IAFF is between 70% and 90%.3 Some studies report an incidence of IAFF for closed fractures of 1% to 2% with an incidence even reaching up to 30% in open fractures.4 However, the real incidence of IAFF is probably underestimated due to a lack of precise definition. When looking at the current literature, many studies have concentrated on prosthetic infections. Most of the applied concepts in the treatment of IAFF are adaptations of algorithms found in prosthetic infections management. It is important to notice that those two identities must be distinguished. While the ultimate goal in the treatment of infected total joint is the eradication of the infection and a sterile implant, the goal of the treatment of an IAFF is the healing of the fracture and the avoiding of chronic osteomyelitis. Furthermore, after consolidation of the bone, the implant can be extricated, contrary to the prosthesis. This allows for a more permissive attitude, with use of suppressive antibiotics until retrieval of the implant. Diagnostics in IAFF can be complicated because identification of the germ is often only possible after intraoperative sampling, in contrast to prosthetic infections where joint aspiration can help preoperatively with diagnostics and establishment of a treatment plan.

[学科分类] 神经科学

[关键词] antibiotic therapy;biofilm;fracture fixation device;fracture-related infection;internal fixation infection;orthopaedic implant infection