Infection after fracture osteosynthesis - Part II

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Fracture osteosynthesis with implants can lead to infection, termed osteosynthesis-associated infection (OAI).
• OAI management often necessitates prolonged antibiotic therapy.
• Maintaining fracture stability and allowing healing despite infection are key considerations.

Purpose of the Study:

• To detail the pathogenesis, clinical presentation, diagnosis, and classification of OAI.
• To outline the five common treatment pathways for OAI.
• To discuss decision-making processes and challenging scenarios in OAI management.

Main Methods:

• Review of pathogenesis, clinical presentation, diagnosis, and classification of OAI.
• Description of five treatment pathways: non-operative, debridement with implant retention, conversion of fixation, implant removal, and suppression therapy.
• Analysis of decision-making criteria based on infection severity, fracture healing, and host status.

Main Results:

• OAI is a significant complication of fracture osteosynthesis requiring tailored treatment.
• Five distinct treatment pathways exist for OAI, guided by clinical and patient-specific factors.
• Implant retention is often feasible and desirable for fracture healing in OAI cases.

Conclusions:

• Effective management of OAI involves a multi-faceted approach considering infection, fracture, and host factors.
• Treatment decisions for OAI are complex and pathway-dependent.
• Successful OAI treatment aims to eradicate infection while ensuring fracture union.