Top

Archives of Orthopaedic and Trauma Surgery

Published in:

Open Access 01-08-2020 | Wound Debridement | Orthopaedic Surgery

General treatment principles for fracture-related infection: recommendations from an international expert group

Authors: Willem-Jan Metsemakers, Mario Morgenstern, Eric Senneville, Olivier Borens, Geertje A. M. Govaert, Jolien Onsea, Melissa Depypere, R. Geoff Richards, Andrej Trampuz, Michael H. J. Verhofstad, Stephen L. Kates, Michael Raschke, Martin A. McNally, William T. Obremskey, On behalf of the Fracture-Related Infection (FRI) group

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2020

Abstract

Fracture-related infection (FRI) remains a challenging complication that creates a heavy burden for orthopaedic trauma patients, their families and treating physicians, as well as for healthcare systems. Standardization of the diagnosis of FRI has been poor, which made the undertaking and comparison of studies difficult. Recently, a consensus definition based on diagnostic criteria for FRI was published. As a well-established diagnosis is the first step in the treatment process of FRI, such a definition should not only improve the quality of published reports but also daily clinical practice. The FRI consensus group recently developed guidelines to standardize treatment pathways and outcome measures. At the center of these recommendations was the implementation of a multidisciplinary team (MDT) approach. If such a team is not available, it is recommended to refer complex cases to specialized centers where a MDT is available and physicians are experienced with the treatment of FRI. This should lead to appropriate use of antimicrobials and standardization of surgical strategies. Furthermore, an MDT could play an important role in host optimization. Overall two main surgical concepts are considered, based on the fact that fracture fixation devices primarily target fracture consolidation and can be removed after healing, in contrast to periprosthetic joint infection were the implant is permanent. The first concept consists of implant retention and the second consists of implant removal (healed fracture) or implant exchange (unhealed fracture). In both cases, deep tissue sampling for microbiological examination is mandatory. Key aspects of the surgical management of FRI are a thorough debridement, irrigation with normal saline, fracture stability, dead space management and adequate soft tissue coverage. The use of local antimicrobials needs to be strongly considered. In case of FRI, empiric broad-spectrum antibiotic therapy should be started after tissue sampling. Thereafter, this needs to be adapted according to culture results as soon as possible. Finally, a minimum follow-up of 12 months after cessation of therapy is recommended. Standardized patient outcome measures purely focusing on FRI are currently not available but the patient-reported outcomes measurement information system (PROMIS) seems to be the preferred tool to assess the patients’ short and long-term outcome. This review summarizes the current general principles which should be considered during the whole treatment process of patients with FRI based on recommendations from the FRI Consensus Group.

Level of evidence: Level V.

Metsemakers WJ, Onsea J, Neutjens E, Steffens E, Schuermans A, McNally M, Nijs S (2017) Prevention of fracture-related infection: a multidisciplinary care package. Int Orthop 41(12):2457–2469. https://doi.org/10.1007/s00264-017-3607-y CrossRefPubMed

Metsemakers WJ, Kuehl R, Moriarty TF, Richards RG, Verhofstad MH, Borens O, Kates S, Morgenstern M (2016) Infection after fracture fixation: current surgical and microbiological concepts. Injury. https://doi.org/10.1016/j.injury.2016.09.019 CrossRefPubMed

Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, Athanasou NA, Ochsner PE, Kuehl R, Raschke M, Borens O, Xie Z, Velkes S, Hungerer S, Kates SL, Zalavras C, Giannoudis PV, Richards RG, Verhofstad MHJ (2018) Fracture-related infection: a consensus on definition from an international expert group. Injury 49(3):505–510. https://doi.org/10.1016/j.injury.2017.08.040 CrossRefPubMed

Govaert GAM, Kuehl R, Atkins BL, Trampuz A, Morgenstern M, Obremskey WT, Verhofstad MHJ, McNally MA, Metsemakers WJ, on behalfof the Fracture-Related Infection (FRI) Consensus Group (2019) Diagnosing fracture-related infection: current concepts and recommendations. J Orthop Trauma. https://doi.org/10.1097/BOT.0000000000001614 CrossRefPubMedCentral

Morgenstern M, Athanasou NA, Ferguson JY, Metsemakers WJ, Atkins BL, McNally MA (2018) The value of quantitative histology in the diagnosis of fracture-related infection. Bone Jt J 100-B(7):966–972. https://doi.org/10.1302/0301-620x.100b7.bjj-2018-0052.r1 CrossRef

Fang C, Wong TM, Lau TW, To KK, Wong SS, Leung F (2017) Infection after fracture osteosynthesis—part I. J Orthop Surg (Hong Kong) 25(1):2309499017692712. https://doi.org/10.1177/2309499017692712 CrossRef

Willenegger H, Roth B (1986) Treatment tactics and late results in early infection following osteosynthesis. Unfallchirurgie 12(5):241–246CrossRefPubMed

Zimmerli W, Sendi P (2017) Orthopaedic biofilm infections. Apmis 125(4):353–364. https://doi.org/10.1111/apm.12687 CrossRefPubMed

Kuehl R, Tschudin-Sutter S, Morgenstern M, Dangel M, Egli A, Nowakowski A, Suhm N, Theilacker C, Widmer AF (2018) Time-dependent differences in management and microbiology of orthopaedic internal fixation-associated infections: an observational prospective study with 229 patients. Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2018.03.040 CrossRefPubMed

10.

Kleber C, Schaser KD, Trampuz A (2015) Complication management of infected osteosynthesis: therapy algorithm for peri-implant infections. Der Chirurg Zeitschrift fur alle Gebiete der operativen Medizen 86(10):925–934. https://doi.org/10.1007/s00104-015-0073-1 CrossRefPubMed

11.

Patzakis MJ, Zalavras CG (2005) Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg 13(6):417–427CrossRefPubMed

12.

Romano CL, Romano D, Logoluso N, Drago L (2011) Bone and joint infections in adults: a comprehensive classification proposal. Eur Orthop Traumatol 1(6):207–217. https://doi.org/10.1007/s12570-011-0056-8 CrossRefPubMedPubMedCentral

13.

Hotchen AJ, McNally MA, Sendi P (2017) The classification of long bone osteomyelitis: a systemic review of the literature. J Bone Jt Infect 2(4):167–174. https://doi.org/10.7150/jbji.21050 CrossRefPubMedPubMedCentral

14.

Greene LR, Mills R, Moss R, Sposato K, Vignari M (2010) The perioperative setting. Association for professionals in infection control and epidemiology. https://apic.org/wp-content/uploads/2019/02/APIC-Ortho-Guide.pdf

15.

Greene LR (2012) Guide to the elimination of orthopedic surgery surgical site infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide. Am J Infect Control 40(4):384–386. https://doi.org/10.1016/j.ajic.2011.05.011 CrossRefPubMed

16.

Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK (2016) Executive summary: implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 62(10):1197–1202. https://doi.org/10.1093/cid/ciw217 CrossRefPubMed

17.

Tamma PD, Cosgrove SE (2011) Antimicrobial stewardship. Infect Dis Clin N Am 25(1):245–260. https://doi.org/10.1016/j.idc.2010.11.011 CrossRef

18.

Goff DA, Kullar R, Goldstein EJC, Gilchrist M, Nathwani D, Cheng AC, Cairns KA, Escandon-Vargas K, Villegas MV, Brink A, van den Bergh D, Mendelson M (2017) A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail. Lancet Infect Dis 17(2):e56–e63. https://doi.org/10.1016/s1473-3099(16)30386-3 CrossRefPubMed

19.

Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E (2016) Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs. Antimicrob Agents Chemother 60(8):4840–4852. https://doi.org/10.1128/aac.00825-16 CrossRefPubMedPubMedCentral

20.

Rodriguez L, Jung HS, Goulet JA, Cicalo A, Machado-Aranda DA, Napolitano LM (2014) Evidence-based protocol for prophylactic antibiotics in open fractures: improved antibiotic stewardship with no increase in infection rates. J Trauma Acute Care Surg 77(3):400–407. https://doi.org/10.1097/ta.0000000000000398(discussion 407–408; quiz 524) CrossRefPubMed

21.

Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM (2007) Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44(2):159–177. https://doi.org/10.1086/510393 CrossRefPubMed

22.

Pulcini C, Binda F, Lamkang AS, Trett A, Charani E, Goff DA, Harbarth S, Hinrichsen SL, Levy-Hara G, Mendelson M, Nathwani D, Gunturu R, Singh S, Srinivasan A, Thamlikitkul V, Thursky K, Vlieghe E, Wertheim H, Zeng M, Gandra S, Laxminarayan R (2018) Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach. Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2018.03.033 CrossRefPubMed

23.

Bezstarosti H, Van Lieshout EMM, Voskamp LW, Kortram K, Obremskey W, McNally MA, Metsemakers WJ, Verhofstad MHJ (2019) Insights into treatment and outcome of fracture-related infection: a systematic literature review. Arch Orthop Trauma Surg 139(1):61–72. https://doi.org/10.1007/s00402-018-3048-0 CrossRefPubMed

24.

Bose D, Kugan R, Stubbs D, McNally M (2015) Management of infected nonunion of the long bones by a multidisciplinary team. Bone Jt J 97-b(6):814–817. https://doi.org/10.1302/0301-620x.97b6.33276 CrossRef

25.

Cierny G 3rd, Mader JT, Penninck JJ (2003) A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res 414:7–24. https://doi.org/10.1097/01.blo.0000088564.81746.62 CrossRef

26.

Bowen TR, Widmaier JC (2005) Host classification predicts infection after open fracture. Clin Orthop Relat Res 433:205–211CrossRef

27.

McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 403:8–15CrossRef

28.

Skaga NO, Eken T, Sovik S, Jones JM, Steen PA (2007) Pre-injury ASA physical status classification is an independent predictor of mortality after trauma. J Trauma 63(5):972–978. https://doi.org/10.1097/TA.0b013e31804a571c CrossRefPubMed

29.

Kay HF, Sathiyakumar V, Yoneda ZT, Lee YM, Jahangir AA, Ehrenfeld JM, Obremskey WT, Apfeld JC, Sethi MK (2014) The effects of American Society of Anesthesiologists physical status on length of stay and inpatient cost in the surgical treatment of isolated orthopaedic fractures. J Orthop Trauma 28(7):e153–e159. https://doi.org/10.1097/01.bot.0000437568.84322.cd CrossRefPubMed

30.

Sankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN (2014) Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth 113(3):424–432. https://doi.org/10.1093/bja/aeu100 CrossRefPubMedPubMedCentral

31.

Sathiyakumar V, Molina CS, Thakore RV, Obremskey WT, Sethi MK (2015) ASA score as a predictor of 30-day perioperative readmission in patients with orthopaedic trauma injuries: an NSQIP analysis. J Orthop Trauma 29(3):e127–e132. https://doi.org/10.1097/bot.0000000000000200 CrossRefPubMed

32.

Ihejirika RC, Thakore RV, Sathiyakumar V, Ehrenfeld JM, Obremskey WT, Sethi MK (2015) An assessment of the inter-rater reliability of the ASA physical status score in the orthopaedic trauma population. Injury 46(4):542–546. https://doi.org/10.1016/j.injury.2014.02.039 CrossRefPubMed

33.

Myers WT, Leong M, Phillips LG (2007) Optimizing the patient for surgical treatment of the wound. Clin Plast Surg 34(4):607–620. https://doi.org/10.1016/j.cps.2007.07.002 CrossRefPubMed

34.

Moller AM, Villebro N, Pedersen T, Tonnesen H (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet (London, England) 359(9301):114–117. https://doi.org/10.1016/s0140-6736(02)07369-5 CrossRef

35.

Lindstrom D, Sadr Azodi O, Wladis A, Tonnesen H, Linder S, Nasell H, Ponzer S, Adami J (2008) Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg 248(5):739–745. https://doi.org/10.1097/SLA.0b013e3181889d0d CrossRefPubMed

36.

Jonsson K, Jensen JA, Goodson WH 3rd, Scheuenstuhl H, West J, Hopf HW, Hunt TK (1991) Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Ann Surg 214(5):605–613CrossRefPubMedPubMedCentral

37.

Gottrup F (2004) Oxygen in wound healing and infection. World J Surg 28(3):312–315. https://doi.org/10.1007/s00268-003-7398-5 CrossRefPubMed

38.

Underwood P, Askari R, Hurwitz S, Chamarthi B, Garg R (2014) Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures. Diabetes Care 37(3):611–616. https://doi.org/10.2337/dc13-1929 CrossRefPubMed

39.

Shah NN, Vetter TR (2018) Comprehensive preoperative assessment and global optimization. Anesthesiol Clin 36(2):259–280. https://doi.org/10.1016/j.anclin.2018.01.006 CrossRefPubMed

40.

Duggan EW, Carlson K, Umpierrez GE (2017) Perioperative hyperglycemia management: an update. Anesthesiology 126(3):547–560. https://doi.org/10.1097/aln.0000000000001515 CrossRefPubMed

41.

Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatcliffe C, Hudson M, Mendoza J, Johnson R, Lin E, Umpierrez GE (2010) Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care 33(8):1783–1788. https://doi.org/10.2337/dc10-0304 CrossRefPubMedPubMedCentral

42.

Richards JE, Hutchinson J, Mukherjee K, Jahangir AA, Mir HR, Evans JM, Perdue AM, Obremskey WT, Sethi MK, May AK (2014) Stress hyperglycemia and surgical site infection in stable nondiabetic adults with orthopedic injuries. J Trauma Acute Care Surg 76(4):1070–1075. https://doi.org/10.1097/ta.0000000000000177 CrossRefPubMed

43.

Richards JE, Kauffmann RM, Obremskey WT, May AK (2013) Stress-induced hyperglycemia as a risk factor for surgical-site infection in nondiabetic orthopedic trauma patients admitted to the intensive care unit. J Orthop Trauma 27(1):16–21. https://doi.org/10.1097/BOT.0b013e31825d60e5 CrossRefPubMedPubMedCentral

44.

Richards JE, Kauffmann RM, Zuckerman SL, Obremskey WT, May AK (2012) Relationship of hyperglycemia and surgical-site infection in orthopaedic surgery. J Bone Jt Surg Am 94(13):1181–1186. https://doi.org/10.2106/jbjs.K.00193 CrossRef

45.

Laird AM, Miller PR, Kilgo PD, Meredith JW, Chang MC (2004) Relationship of early hyperglycemia to mortality in trauma patients. J Trauma 56(5):1058–1062CrossRefPubMed

46.

Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM (2005) Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 59(1):80–83CrossRefPubMed

47.

WHO (2016) Preoperative and/or intraoperative measures. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/250680/9789241549882-eng.pdf?sequence=8

48.

Sebranek JJ, Lugli AK, Coursin DB (2013) Glycaemic control in the perioperative period. Br J Anaesth 111(Suppl 1):i18–i34. https://doi.org/10.1093/bja/aet381 CrossRefPubMed

49.

WHO (2015) Action plan to reduce the double burden of malnutrition in the Western Pacific Region (2015–2020). World Health Organization Regional Office for the Western Pacific, Manila

50.

Ida M, Naito Y, Matsunari Y, Tanaka Y, Inoue S, Kawaguchi M (2018) Prevalence and associated factors of preoperative functional disability in elective surgical patients over 55 years old: a prospective cohort study. J Anesth. https://doi.org/10.1007/s00540-018-2490-z CrossRefPubMed

51.

Fournier MN, Hallock J, Mihalko WM (2016) Preoperative optimization of total joint arthroplasty surgical risk: obesity. J Arthroplasty 31(8):1620–1624. https://doi.org/10.1016/j.arth.2016.02.085 CrossRefPubMed

52.

Ernst A, Wilson JM, Ahn J, Shapiro M, Schenker ML (2018) Malnutrition and the orthopaedic trauma patient: a systematic review of the literature. J Orthop Trauma 32(10):491–499. https://doi.org/10.1097/bot.0000000000001254 CrossRefPubMed

53.

Gupta R, Gan TJ (2016) Preoperative nutrition and prehabilitation. Anesthesiol Clin 34(1):143–153. https://doi.org/10.1016/j.anclin.2015.10.012 CrossRefPubMed

54.

Arnold M, Barbul A (2006) Nutrition and wound healing. Plast Reconstr Surg 117(7 Suppl):42s–58s. https://doi.org/10.1097/01.prs.0000225432.17501.6c CrossRefPubMed

55.

Inkrott BP, Koberling JL, Noel CR (2016) Hypovitaminosis D in patients undergoing shoulder arthroplasty: a single-center analysis. Orthopedics 39(4):e651–e656. https://doi.org/10.3928/01477447-20160606-04 CrossRefPubMed

56.

Maniar RN, Patil AM, Maniar AR, Gangaraju B, Singh J (2016) Effect of preoperative vitamin D levels on functional performance after total knee arthroplasty. Clin Orthop Surg 8(2):153–156. https://doi.org/10.4055/cios.2016.8.2.153 CrossRefPubMedPubMedCentral

57.

Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338(12):777–783. https://doi.org/10.1056/nejm199803193381201 CrossRefPubMed

58.

Bogunovic L, Kim AD, Beamer BS, Nguyen J, Lane JM (2010) Hypovitaminosis D in patients scheduled to undergo orthopaedic surgery: a single-center analysis. J Bone Jt Surg Am 92(13):2300–2304. https://doi.org/10.2106/jbjs.I.01231 CrossRef

59.

Brinker MR, O’Connor DP, Monla YT, Earthman TP (2007) Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma 21(8):557–570. https://doi.org/10.1097/BOT.0b013e31814d4dc6 CrossRefPubMed

60.

Sprague S, Petrisor B, Scott T, Devji T, Phillips M, Spurr H, Bhandari M, Slobogean GP (2016) What is the role of vitamin D supplementation in acute fracture patients? A systematic review and meta-analysis of the prevalence of hypovitaminosis d and supplementation efficacy. J Orthop Trauma 30(2):53–63. https://doi.org/10.1097/bot.0000000000000455 CrossRefPubMed

61.

Haines N, Kempton LB, Seymour RB, Bosse MJ, Churchill C, Hand K, Hsu JR, Keil D, Kellam J, Rozario N, Sims S, Karunakar MA (2017) The effect of a single early high-dose vitamin D supplement on fracture union in patients with hypovitaminosis D: a prospective randomised trial. Bone Jt J 99-b(11):1520–1525. https://doi.org/10.1302/0301-620x.99b11.bjj-2017-0271.r1 CrossRef

62.

Legare F, Stacey D, Turcotte S, Cossi MJ, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N (2014) Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev (9):Cd006732. https://doi.org/10.1002/14651858.cd006732.pub3

63.

Schmidt AH, Swiontkowski MF (2000) Pathophysiology of infections after internal fixation of fractures. J Am Acad Orthop Surg 8(5):285–291CrossRefPubMed

64.

Rittmann WW, Perren SM (1974) Cortical bone healing after internal fixation and infection. Springer, BerlinCrossRef

65.

Berkes M, Obremskey WT, Scannell B, Ellington JK, Hymes RA, Bosse M (2010) Maintenance of hardware after early postoperative infection following fracture internal fixation. J Bone Jt Surg Am 92(4):823–828. https://doi.org/10.2106/jbjs.I.00470 CrossRef

66.

Hak DJ, Fitzpatrick D, Bishop JA, Marsh JL, Tilp S, Schnettler R, Simpson H, Alt V (2014) Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury 45(Suppl 2):S3–S7. https://doi.org/10.1016/j.injury.2014.04.002 CrossRefPubMed

67.

Dudareva M, Barrett L, Figtree M, Scarborough M, Watanabe M, Newnham R, Wallis R, Oakley S, Kendrick B, Stubbs D, McNally MA, Bejon P, Atkins BA, Taylor A, Brent AJ (2018) Sonication versus tissue sampling for diagnosis of prosthetic joint and other orthopedic device-related infections. J Clin Microbiol. https://doi.org/10.1128/jcm.00688-18 CrossRefPubMedPubMedCentral

68.

Hellebrekers P, Rentenaar RJ, McNally MA, Hietbrink F, Houwert RM, Leenen LPH, Govaert GAM (2019) Getting it right first time: the importance of a structured tissue sampling protocol for diagnosing fracture-related infections. Injury. https://doi.org/10.1016/j.injury.2019.05.014 CrossRefPubMed

69.

Onsea J, Depypere M, Govaert G, Kuehl R, Vandendriessche T, Morgenstern M, McNally M, Trampuz A, Metsemakers WJ (2018) Accuracy of tissue and sonication fluid sampling for the diagnosis of fracture-related infection: a systematic review and critical appraisal. J Bone Jt Infect 3(4):173–181. https://doi.org/10.7150/jbji.27840 CrossRefPubMedPubMedCentral

70.

Tetsworth K, Cierny G 3rd (1999) Osteomyelitis debridement techniques. Clin Orthop Relat Res 360:87–96. https://doi.org/10.1097/00003086-199903000-00011 CrossRef

71.

Bhandari M, Jeray KJ, Petrisor BA, Devereaux PJ, Heels-Ansdell D, Schemitsch EH, Anglen J, Della Rocca GJ, Jones C, Kreder H, Liew S, McKay P, Papp S, Sancheti P, Sprague S, Stone TB, Sun X, Tanner SL, Tornetta P 3rd, Tufescu T, Walter S, Guyatt GH (2015) A trial of wound irrigation in the initial management of open fracture wounds. N Engl J Med 373(27):2629–2641. https://doi.org/10.1056/NEJMoa1508502 CrossRefPubMed

72.

Anglen JO (2001) Wound irrigation in musculoskeletal injury. J Am Acad Orthop Surg 9(4):219–226CrossRefPubMed

73.

Draeger RW, Dahners LE (2006) Traumatic wound debridement: a comparison of irrigation methods. J Orthop Trauma 20(2):83–88. https://doi.org/10.1097/01.bot.0000197700.19826.db CrossRefPubMed

74.

Yun HC, Murray CK, Nelson KJ, Bosse MJ (2016) Infection after orthopaedic trauma: prevention and treatment. J Orthop Trauma 30(Suppl 3):S21–S26. https://doi.org/10.1097/bot.0000000000000667 CrossRefPubMed

75.

Ferguson JY, Dudareva M, Riley ND, Stubbs D, Atkins BL, McNally MA (2014) The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: a series of 195 cases. Bone Jt J 96-b(6):829–836. https://doi.org/10.1302/0301-620x.96b6.32756 CrossRef

76.

Morgenstern M, Vallejo A, McNally MA, Moriarty TF, Ferguson JY, Nijs S, Metsemakers WJ (2018) The effect of local antibiotic prophylaxis when treating open limb fractures: a systematic review and meta-analysis. Bone Jt Res 7(7):447–456. https://doi.org/10.1302/2046-3758.77.Bjr-2018-0043.R1 CrossRef

77.

Hake ME, Young H, Hak DJ, Stahel PF, Hammerberg EM, Mauffrey C (2015) Local antibiotic therapy strategies in orthopaedic trauma: practical tips and tricks and review of the literature. Injury 46(8):1447–1456. https://doi.org/10.1016/j.injury.2015.05.008 CrossRefPubMed

78.

Cooper C, Horner C, Barlow G, Stryja J, Sandy-Hodgetts K, Guise T, Humphreys H (2018) A survey of practice and opinions on the use of topical antibiotics to prevent surgical site infection: more confusion than consensus. J Antimicrob Chemother. https://doi.org/10.1093/jac/dky097 CrossRefPubMedPubMedCentral

79.

Metsemakers WJ, Fragomen AT, Moriarty TF, Morgenstern M, Egol KA, Zalavras C, Obremskey WT, Raschke M, McNally MA, on behalf of the Fracture-Related Infection (FRI) Consensus Group (2019) Diagnosing fracture-related infection: current concepts and recommendations. J Orthop Trauma. https://doi.org/10.1097/BOT.0000000000001615 CrossRefPubMedCentral

80.

Kadhim M, Holmes L Jr, Gesheff MG, Conway JD (2017) Treatment options for nonunion with segmental bone defects: systematic review and quantitative evidence synthesis. J Orthop Trauma 31(2):111–119. https://doi.org/10.1097/bot.0000000000000700 CrossRefPubMed

81.

Bezstarosti H, Metsemakers WJ, Van Lieshout EMM, Voskamp LW, Kortram K, Mcnally MA, Marais LC, Verhofstad MHJ (2019) Management of critical-sized bone defects in treatment of complex fracture-related infection; a systematic review and pooled analysis. J Orthop Res. (Under review)

82.

McNally MA, Ferguson JY, Lau AC, Diefenbeck M, Scarborough M, Ramsden AJ, Atkins BL (2016) Single-stage treatment of chronic osteomyelitis with a new absorbable, gentamicin-loaded, calcium sulphate/hydroxyapatite biocomposite: a prospective series of 100 cases. Bone Joint J 98-b(9):1289–1296. https://doi.org/10.1302/0301-620x.98b9.38057 CrossRefPubMed

83.

Mehta D, Abdou S, Stranix JT, Levine JP, McLaurin T, Tejwani N, Thanik V, Leucht P (2018) Comparing radiographic progression of bone healing in Gustilo IIIB open tibia fractures treated with muscle versus fasciocutaneous flaps. J Orthop Trauma 32(8):381–385. https://doi.org/10.1097/bot.0000000000001190 CrossRefPubMed

84.

Ovaska MT, Madanat R, Tukiainen E, Pulliainen L, Sintonen H, Makinen TJ (2014) Flap reconstruction for soft-tissue defects with exposed hardware following deep infection after internal fixation of ankle fractures. Injury 45(12):2029–2034. https://doi.org/10.1016/j.injury.2014.10.006 CrossRefPubMed

85.

Salgado CJ, Mardini S, Jamali AA, Ortiz J, Gonzales R, Chen HC (2006) Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects. Plast Reconstr Surg 118(6):1401–1411. https://doi.org/10.1097/01.prs.0000239579.37760.92 CrossRefPubMed

86.

Fallico N, Somma F, Cigna E, Dessy LA, Tarallo M, Ribuffo D (2015) Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps. Eur Rev Med Pharmacol Sci 19(24):4715–4721PubMed

87.

Cho EH, Shammas RL, Carney MJ, Weissler JM, Bauder AR, Glener AD, Kovach SJ, Hollenbeck ST, Levin LS (2018) Muscle versus fasciocutaneous free flaps in lower extremity traumatic reconstruction: a multicenter outcomes analysis. Plast Reconstr Surg 141(1):191–199. https://doi.org/10.1097/prs.0000000000003927 CrossRefPubMed

88.

Chan JK, Harry L, Williams G, Nanchahal J (2012) Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps. Plast Reconstr Surg 130(2):284e–295e. https://doi.org/10.1097/PRS.0b013e3182589e63 CrossRefPubMedPubMedCentral

89.

Yusuf E, Jordan X, Clauss M, Borens O, Mader M, Trampuz A (2013) High bacterial load in negative pressure wound therapy (NPWT) foams used in the treatment of chronic wounds. Wound Repair Regen 21(5):677–681. https://doi.org/10.1111/wrr.12088 CrossRefPubMed

90.

Li HK, Rombach I, Zambellas R, Walker AS, McNally MA, Atkins BL, Lipsky BA, Hughes HC, Bose D, Kumin M, Scarborough C, Matthews PC, Brent AJ, Lomas J, Gundle R, Rogers M, Taylor A, Angus B, Byren I, Berendt AR, Warren S, Fitzgerald FE, Mack DJF, Hopkins S, Folb J, Reynolds HE, Moore E, Marshall J, Jenkins N, Moran CE, Woodhouse AF, Stafford S, Seaton RA, Vallance C, Hemsley CJ, Bisnauthsing K, Sandoe JAT, Aggarwal I, Ellis SC, Bunn DJ, Sutherland RK, Barlow G, Cooper C, Geue C, McMeekin N, Briggs AH, Sendi P, Khatamzas E, Wangrangsimakul T, Wong THN, Barrett LK, Alvand A, Old CF, Bostock J, Paul J, Cooke G, Thwaites GE, Bejon P, Scarborough M (2019) Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med 380(5):425–436. https://doi.org/10.1056/NEJMoa1710926 CrossRefPubMedPubMedCentral

91.

Depypere M, Kuehl R, Metsemakers WJ, Senneville E, McNally MA, Obremskey WT, Zimmerli W, Atkins BL, Trampuz A, on behalf of the Fracture-Related Infection (FRI) Consensus Group (2019) Recommendations for antimicrobial therapy in fracture-related infection: a consensus from an international expert group. J Orthop Trauma. https://doi.org/10.1097/BOT.0000000000001626 CrossRefPubMedCentral

92.

van den Kieboom J, Bosch P, Plate JDJ, IJpma FFA, Kuehl R, McNally MA, Metsemakers WJ, Govaert GAM (2018) Diagnostic accuracy of serum inflammatory markers in late fracture-related infection. Bone Jt J 100-b(12):1542–1550. https://doi.org/10.1302/0301-620x.100b12.bjj-2018-0586.r1 CrossRef

93.

Gartland JJ (1988) Orthopaedic clinical research. Deficiencies in experimental design and determinations of outcome. J Bone Jt Surg Am 70(9):1357–1364CrossRef

94.

Gross M (1988) A critique of the methodologies used in clinical studies of hip-joint arthroplasty published in the English-language orthopaedic literature. J Bone Jt Surg Am 70(9):1364–1371CrossRef

95.

Keller RB (1993) Outcomes research in orthopaedics. J Am Acad Orthop Surg 1(2):122–129CrossRefPubMed

96.

Keller RB, Rudicel SA, Liang MH (1994) Outcomes research in orthopaedics. Instr Course Lect 43:599–611PubMed

97.

Keller RB, Soule DN, Wennberg JE, Hanley DF (1990) Dealing with geographic variations in the use of hospitals. The experience of the Maine Medical Assessment Foundation Orthopaedic Study Group. J Bone Jt Surg Am 72(9):1286–1293CrossRef

98.

Guyatt GH, Feeny DH, Patrick DL (1993) Measuring health-related quality of life. Ann Intern Med 118(8):622–629CrossRefPubMed

99.

Patrick DL, Bergner M (1990) Measurement of health status in the 1990s. Annu Rev Public Health 11:165–183. https://doi.org/10.1146/annurev.pu.11.050190.001121 CrossRefPubMed

100.

Simmons BP, Swiontkowski MF, Evans RW, Amadio PC, Cats-Baril W (1999) Outcomes assessment in the information age: available instruments, data collection, and utilization of data. Instr Course Lect 48:667–685PubMed

101.

Brodke DJ, Hung M, Bozic KJ (2016) Item response theory and computerized adaptive testing for orthopaedic outcomes measures. J Am Acad Orthop Surg 24(11):750–754. https://doi.org/10.5435/jaaos-d-15-00420 CrossRefPubMed

102.

Morgan JH, Kallen MA, Okike K, Lee OC, Vrahas MS (2015) PROMIS physical function computer adaptive test compared with other upper extremity outcome measures in the evaluation of proximal humerus fractures in patients older than 60 years. J Orthop Trauma 29(6):257–263. https://doi.org/10.1097/bot.0000000000000280 CrossRefPubMed

103.

Tyser AR, Beckmann J, Franklin JD, Cheng C, Hon SD, Wang A, Hung M (2014) Evaluation of the PROMIS physical function computer adaptive test in the upper extremity. J Hand Surg 39(10):2047–2051.e2044. https://doi.org/10.1016/j.jhsa.2014.06.130 CrossRef

Title: General treatment principles for fracture-related infection: recommendations from an international expert group
Authors: Willem-Jan Metsemakers
Mario Morgenstern
Eric Senneville
Olivier Borens
Geertje A. M. Govaert
Jolien Onsea
Melissa Depypere
R. Geoff Richards
Andrej Trampuz
Michael H. J. Verhofstad
Stephen L. Kates
Michael Raschke
Martin A. McNally
William T. Obremskey
On behalf of the Fracture-Related Infection (FRI) group
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Wound Debridement
Antibiotic
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03287-4

At a glance: The STEP trials

Springer Medicine

General treatment principles for fracture-related infection: recommendations from an international expert group

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2020

Additional benefits of multiple-dose tranexamic acid to anti-fibrinolysis and anti-inflammation in total knee arthroplasty: a randomized controlled trial

Traumatic brain injury enhances the formation of heterotopic ossification around the hip: an animal model study

Management of intraarticular proximal interphalangeal joint fracture-dislocations and pilon fractures with the Ligamentotaxor® device

Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study

ACL injuries before 15 years of age: could the young become an athlete?

Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation