Hardware considerations in infection and nonunion management

Abstract

The occurrence of both nonunion and fracture-related infection provides challenges for both the patient and the treating orthopaedic surgeon, with the potential need for complex reconstructive procedures to achieve union and/or eradicate infection. In addition to addressing the multiple different factors that often contribute to nonunion, surgeons are often forced to deal with difficult hardware issues at the time of revision surgery including infected hardware, loose or failing hardware, malaligned hardware, or inappropriate hardware constructs. This article reviews common causes of nonunions with emphasis on infection management and provides indications and techniques for hardware removal in the context of an algorithmic approach to nonunion management with illustrative case examples.

Therapeutic Efficacy and Safety of Osteoinductive Factors and Cellular Therapies for Long Bone Fractures and Non-Unions: A Meta-Analysis and Systematic Review

“…This could be explained by the fact that long bone fractures treated without BMP application were more prone to hardware failure due to either delayed healing or lower bone healing rates in general compared to BMP groups. It is particularly evident that the biomechanical stability of the construct is negatively affected in non-unions and is a major concern for future broken implants [63].…”

Case report: Restoration of an open 12 cm femoral defect treated with the Masquelet technique in a 20-year-old polytrauma

“…The management of the posttraumatic segmental bone defects associated without or with infections is very challenging both to the patient and surgeon. In infected post-traumatic bone defects, irrigation and debridement, soft-tissue reconstruction and establishing an aseptic environment with subsequent application of regenerative techniques to restore the bone that is missing remain the mainstay of treatment [1] . Regenerative techniques that can be applied include bone transport [6] , vascularized bone transfer [6] , titanium cages and allograft [7] .…”

“…Significant bone defects associated with infection pose a great challenge to the surgeon. Treatment consists of thorough irrigation and debridement, addressing the soft-tissue, stabilizing the bone and definitively reconstructing the defect when the infection has been eradicated [1] . The end-goal of management is to have an aseptic restoration of the defect associated with good functional outcomes.…”

Case report: Forearm infected non-united fracture managed with the Masquelet technique in a 71-year-old female patient

“…Although the data is more scarce compared to periprosthetic joint infection, infection following fracture fixation has an estimated 1–2% incidence [1] and may be up to 30% for open fractures [1] , [3] , and predisposes to nonunion [4] . The management of infected nonunions following fracture fixation can be typically long lasting and challenging for both patient and surgeon.…”

“…The management of infected nonunions following fracture fixation can be typically long lasting and challenging for both patient and surgeon. In addition the impact to society is huge as many of those patients lose their ability to return to work, may have profound quality of life and psychological sequelae and considerable burden to the healthcare system [4] , [5] .…”