Management of Chronic Fracture-Related Infection.

Chronic fracture-related infection is a complex, costly clinical problem with a wide spectrum of clinical presentations. The goals of treatment are infection control with a healed fracture covered by well-vascularized soft tissue and improvement of patient pain and function. Management is both medical, with culture-targeted antimicrobial agents, and surgical, requiring meticulous irrigation and débridement.

Management of Acute and Subacute Fracture-Related Infection.

Fracture-related infection (FRI) is a serious complication that occurs primarily in surgically treated fractures. FRIs occur when bacteria enter the site of bony injury and alter the healing inflammatory response within the bone. This can prevent bone regeneration and can lead to long-lasting complications such as chronic infection, pain, nonunion, and amputation.

Prevention of Fracture-Related Infection.

Fracture-related infections are a significant burden to the patient, associated with high health care costs and use of resources. Therefore, prevention is more critical than treatment of infection. There are injury- and patient-related risk factors that are mostly not modifiable, with the exception of a few patient-specific ones such as control of blood glucose levels in patients with diabetes.

Diagnosis and Evaluation of Fracture-Related Infection.

Following fracture fixation, fracture-related infection (FRI) is a common complication and requires systematic evaluation to allow for an optimal treatment strategy. A high index of suspicion is necessary for early and timely diagnosis, to diagnose occult infection, and to prevent untreated infections from worsening. Diagnosis of FRI includes evaluation based on history and clinical examination, surgical exploration, serum inflammatory markers, imaging modalities, microbiology, histopathology, and, when needed, molecular biology.

Disintegration of Multiple Parts of a Bone Transport Nail During Planned Removal: A Case Report.

Case: A 34-year-old man with a distal tibia bone defect was treated with an intramedullary bone transport nail (Precice Bone Transport System, NuVasive). During planned removal after successful treatment, 7 separate subcomponents of the nail became disconnected and had to be separately removed using specialized instrumentation. This occurred despite adherence to the manufacturer's recommended technique for nail removal and in the absence of clinical or radiographic evidence of implant failure.