Infection after fracture fixation

Overview

This 2019 review in EFORT Open Reviews by Steinmetz, Wernly, Moerenhout, Trampuz and Borens addresses infection after fracture fixation, a feared complication that can lead to non-union, loss of function and even amputation. It argues that these infections differ from prosthetic joint infection and need their own diagnostic and treatment strategy.

Who it is for

Orthopaedic and trauma surgeons, plastic surgeons, infectious disease specialists and microbiologists managing patients with internal fixation devices.

Key areas covered

The review sets out the internationally agreed definition of fracture-related infection developed with the AO Foundation, which replaced earlier approaches borrowed from prosthetic infection care. It describes the clinical, radiological and laboratory signs that raise suspicion of infection. It also explains why trauma patients, with more soft tissue damage and sometimes direct contamination from open fractures, carry a different risk profile from elective surgical patients.

Notable emphasis

A central point is that the goal of treatment differs from joint replacement. The aim is fracture healing and avoiding chronic osteomyelitis rather than a sterile permanent implant, and hardware can often be removed once the bone has united. The authors stress early detection, mechanical stability, interdisciplinary care, and eradication through combined surgical and antibiotic treatment guided by intra-operative tissue samples.

How to use this guideline

The article presents a treatment algorithm for day-to-day decision-making. Readers should consult the full text for its detailed criteria and apply it alongside local microbiology input.