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

Details

Serval ID
serval:BIB_982FC4FBB0D2
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
General treatment principles for fracture-related infection: recommendations from an international expert group.
Journal
Archives of orthopaedic and trauma surgery
Author(s)
Metsemakers W.J., Morgenstern M., Senneville E., Borens O., Govaert GAM, Onsea J., Depypere M., Richards R.G., Trampuz A., Verhofstad MHJ, Kates S.L., Raschke M., McNally M.A., Obremskey W.T.
Working group(s)
Fracture-Related Infection (FRI) group
Contributor(s)
Metsemakers W.J., Obremskey W.T., McNally M.A., Athanasou N., Atkins B.L., Borens O., Depypere M., Eckardt H., Egol K.A., Foster W., Fragomen A.T., Govaert GAM, Hungerer S., Kates S.L., Kuehl R., Marais L., Mcfadyen I., Morgenstern M., Moriarty T.F., Ochsner P., Ramsden A., Raschke M., Richards R.G., Sancineto C., Zalavras C., Senneville E., Trampuz A., Verhofstad MHJ, Zimmerli W.
ISSN
1434-3916 (Electronic)
ISSN-L
0936-8051
Publication state
Published
Issued date
08/2020
Peer-reviewed
Oui
Volume
140
Number
8
Pages
1013-1027
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
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.
Keywords
Anti-Bacterial Agents/therapeutic use, Bacterial Infections, Consensus, Fracture Fixation, Internal/adverse effects, Fractures, Bone/complications, Fractures, Bone/surgery, Humans, Practice Guidelines as Topic, Surgical Wound Infection, Diagnosis, Fracture, Fracture-related infection, Infection, Outcome, Treatment
Pubmed
Web of science
Open Access
Yes
Create date
07/01/2020 13:04
Last modification date
09/04/2024 7:14
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