Surgical treatment of fracture-related infection Part I: Bone and soft tissue debridement

Authors

DOI:

https://doi.org/10.58814/01208845.57

Keywords:

Surgical Wound Infection, Fracture Fixation, Osteomyelitis, Debridement

Abstract

Fracture-related infection (FRI) is a severe complication of the surgical treatment of traumatic bone injuries and occurs more frequently in patients with such injuries than in those undergoing elective joint replacement surgery. The surgical treatment of FRI is based on meticulous bone and soft tissue debridement, dead space management, reconstruction of soft tissue defects, and restoration of bone stability in non-union fractures. Furthermore, the use of local antibiotic therapy is recommended in some cases. The objective of this article was to review the current concepts of available techniques for the surgical treatment of FRI, with emphasis on bone and soft tissue debridement.

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References

Moriarty TF, Metsemakers WJ, Morgenstern M, Hofstee MI, Vallejo Diaz A, Cassat JE, et al. Fracture-related infection. Nat Rev Dis Primers. 2022;8(1):67. https://doi.org/mq9t.

Trampuz A and Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury, 2006;37(Suppl 2):S59-66. https://doi.org/d8dr9x.

Steinmetz S, Wernly D, Moerenhout K, Trampuz A, Borens O. Infection after fracture fixation. EFORT Open Rev. 2019;4(7):468-75. https://doi.org/ghmfwf.

Alcântara JJ, Aguiar RA, Sampaio JN, Azi ML, Sadigursky D, Alencar DF. Factors Associated with the Development of Early Infection after Surgical Treatment of Fractures. Acta Ortop Bras. 2018;26(1):22-6. https://doi.org/mq9v.

Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, et al. Fracture-related infection: A consensus on definition from an international expert group. Injury. 2018;49(3):505-10. https://doi.org/gdcrpb.

Schlickewei CW, Yarar S, Rueger JM. Eluting antibiotic bone graft substitutes for the treatment of osteomyelitis in long bones. A review: evidence for their use? Orthop Res Rev. 2014(6):71-9. https://doi.org/mq9z.

Obremskey WT, Metsemakers WJ, Schlatterer DR, Tetsworth K, Egol K, Kates S, et al. Musculoskeletal Infection in Orthopaedic Trauma: Assessment of the 2018 International Consensus Meeting on Musculoskeletal Infection. J Bone Joint Surg Am. 2020;102(10):e44. https://doi.org/mrbb.

Onsea J, Van Lieshout EMM, Zalavras C, Sliepen J, Depypere M, Noppe N, et al. Validation of the diagnostic criteria of the consensus definition of fracture-related infection. Injury. 2022;53(6):1867-79. https://doi.org/gtkhjt.

Zimmerli W, Sendi P. Orthopaedic biofilm infections. 2017;125(4):353-64. https://doi.org/f93mc5.

Depypere M, Morgenstern M, Kuehl R, Senneville E, Moriarty TF, Obremskey WT, et al. Pathogenesis and management of fracture-related infection. Clin Microbiol Infect. 2020;26(5):572-8. https://doi.org/ghw9rh.

Metsemakers WJ, Morgenstern M, Senneville E, Borens O, Govaert GAM, Onsea J, et al. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg. 2020;140(8):1013-27. https://doi.org/ghmfvw.

Depypere M, Kuehl R, Metsemakers WJ, Senneville E, McNally MA, Obremskey WT, et al. Recommendations for Systemic Antimicrobial Therapy in Fracture-Related Infection: A Consensus From an International Expert Group. J Orthop Trauma. 2020;34(1):30-41. https://doi.org/ghx7c2.

Waldvogel FA, Medoff G, Swartz MN. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med. 1970;282(4):198-206. https://doi.org/bqkpdm.

Hotchen AJ, McNally MA, Sendi P. The Classification of Long Bone Osteomyelitis: A Systemic Review of the Literature. J Bone Jt Infect. 2017;2(4):167-74. https://doi.org/gckbzb.

Panteli M, Giannoudis PV. Chronic osteomyelitis: what the surgeon needs to know. EFORT Open Rev. 2016;1(5):128-35. https://doi.org/mrbf.

Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am. 2004;86(10):2305-18. https://doi.org/gq4pqt.

Schnettler R, Steinau HU. Septic bone and joint surgery. Stuttgart: Thieme, 2010.

Ochsner PE, Hailemariam S. Histology of osteosynthesis associated bone infection. Injury. 2006;37(Suppl 2):S49-58. https://doi.org/d95qcf.

Willenegger H, Roth B. Behandlungstaktik und Spätergebnisse bei Frühinfekt nach Osteosynthese [Treatment tactics and late results in early infection following osteosynthesis]. Unfallchirurgie. 1986;12(5):241-6. https://doi.org/dwgjwj.

Morgenstern M, Moriarty TF, Kuehl R, Richards RG, McNally MA, Verhofstad MHJ, et al. International survey among orthopaedic trauma surgeons: Lack of a definition of fracture-related infection. Injury. 2018;49(3):491-6. https://doi.org/gdcmsk.

Morgenstern M, Kuehl R, Zalavras CG, McNally M, Zimmerli W, Burch MA, et al. The influence of duration of infection on outcome of debridement and implant retention in fracture-related infection. Bone Joint J. 2021;103-B(2):213-21. https://doi.org/gqtt8n.

Walter G, Kemmerer M, Kappler C, Hoffmann R. Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int. 2012;109(14):257-64. https://doi.org/mrbk.

Metsemakers WJ, Kuehl R, Moriarty TF, Richards RG, Verhofstad MHJ, Borens O, et al. Infection after fracture fixation: Current surgical and microbiological concepts. Injury. 2018;49(3):511-22. https://doi.org/gdcmq9.

Govaert GAM, Kuehl R, Atkins BL, Trampuz A, Morgenstern M, Obremskey WT, et al. Diagnosing Fracture-Related Infection: Current Concepts and Recommendations. J Orthop Trauma. 2020;34(1):8-17. https://doi.org/ghmfwd.

Marais LC, Hungerer S, Eckardt H, Zalavras C, Obremskey WT, Ramsden A, et al. Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg. 2024;144(1):259-68. https://doi.org/mrbn.

Walenkamp GH. How I do it: Chronic osteomyelitis. Acta Orthop Scand. 1997;68(5):497-506. https://doi.org/csvszt.

Parsons B, Strauss E. Surgical management of chronic osteomyelitis. Am J Surg. 2004;188(Suppl 1A):57-66. https://doi.org/bmtmdw.

Diefenbeck M, Haustedt N, Schmidt HGK. Surgical debridement to optimise wound conditions and healing. Int Wound J. 2013;10 (Suppl 1):43-7. https://doi.org/mrbp.

Shaw JD, Miller S, Plourde A, Shaw DL, Wustrack R, Hansen EN. Methylene Blue-Guided Debridement as an Intraoperative Adjunct for the Surgical Treatment of Periprosthetic Joint Infection. J Arthroplasty. 2017;32(12):3718-23. https://doi.org/gc3jk3.

Khan W, Morgan-Jones R. Debridement: Defining something we all do. J Trauma Orthop. 2016;4(1):48-50.

Rightmire E, Zurakowski D, Vrahas M. Acute infections after fracture repair: management with hardware in place. Clin Orthop Relat Res. 2008;466(2):466-72. https://doi.org/fhwx8v.

Tetsworth K, Cierny G 3rd. Osteomyelitis debridement techniques. Clin Orthop Relat Res. 1999;360:87-96. https://doi.org/fjz9gm.

Tiemann AH, Schmidt HGK, Braunschweig R, Hofmann GO. Strategies for the analysis of osteitic bone defects at the diaphysis of long bones. Strategies Trauma Limb Reconstr. 2009;4(1):13-8. 2009/03/17. https://doi.org/bjf2gt.

Marais LC, Ferreira N, Aldous C, Le Roux T. The management of chronic osteomyelitis: Part I - Diagnostic work-up and surgical principles. SA Orthopaedic Journal. 2014;13(2):42-8.

Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg. 2005;13(6):417-27. https://doi.org/gnphgf.

Sancineto CF, Pereira-Duarte M, Garcia-Mansilla I, Taype Zamboni DRE, Carabelli GS, Barla JD. Preliminary outcomes of proximal femur megaspacers. Arthroplast Today. 2019;5(2):164-71. https://doi.org/mrbm.

Elhessy AH, Rivera JC, Shu HT, Andrews TJ, Herzenberg JE, Conway JD. Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis. Strategies Trauma Limb Reconstr. 2022;17(2):123-30. https://doi.org/mrb2.

Dudareva M, Barrett LK, Morgenstern M, Atkins BL, Brent AJ, McNally MA. Providing an Evidence Base for Tissue Sampling and Culture Interpretation in Suspected Fracture-Related Infection. J Bone Joint Surg Am. 2021;103(11):977-83. https://doi.org/mrb4.

Hellebrekers P, Rentenaar RJ, McNally MA, Hietbrink F, Houwert RM, Leenen LPH, et al. Getting it right first time: The importance of a structured tissue sampling protocol for diagnosing fracture-related infections. Injury. 2019;50(10):1649-55. https://doi.org/gsjv7d.

Bezstarosti H, Van Lieshout EMM, Voskamp LW, Kortram K, Obremskey W, McNally MA, et al. Insights into treatment and outcome of fracture-related infection: a systematic literature review. Arch Orthop Trauma Surg. 2019;139(1):61-72. https://doi.org/gmgvms.

Published

2024-01-31

How to Cite

1.
Azi ML, Valderrama-Molina CO, Vallejo-Díaz A, Día-Belangero W, Giordano V, Carabelli G, et al. Surgical treatment of fracture-related infection Part I: Bone and soft tissue debridement. Rev. Colomb. Ortop. Traumatol. [Internet]. 2024 Jan. 31 [cited 2025 May 11];38(1):e57. Available from: https://revistasccotorg.biteca.online/index.php/rccot/article/view/57

Issue

Section

Review article