Integrating Super-Oxidised Solutions into Multimodal Strategies for Orthopaedic Infection Prevention and Management

Fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) remain among the most challenging complications in orthopaedic surgery, often requiring prolonged and multidisciplinary management. Standard approaches-such as surgical debridement, implant retention or removal, and systemic antibiotic therapy-may be limited in effectiveness, particularly in patients with significant comorbidities or high surgical risk. This study explores the adjunctive use of super-oxidised solutions (SOS) within existing treatment protocols for orthopaedic infections. It provides a comprehensive overview of their practical application, including intraoperative lavage, postoperative wound care, and integration with negative pressure wound therapy with instillation (NPWT-i). Importantly, this work introduces a structured treatment algorithm designed to guide clinicians in the systematic use of SOS as part of multimodal infection management strategies. By synthesising available preclinical and clinical data, the study aims to bridge the gap between theoretical understanding and clinical practice. SOS are presented as complementary tools intended to support, not replace, surgical intervention and systemic antimicrobial therapy. Their use may offer additional support in complex cases, particularly in patients for whom traditional approaches alone may be insufficient. This framework is intended to assist clinicians in decision-making and protocol development, with the goal of improving consistency, safety, and outcomes in the management of FRIs and PJIs.