Komplikationsmanagement bei infizierter Osteosynthese

Kleber, Christian; Schaser, K.-D.; Trampuž, Andrej

doi:10.1007/s00104-015-0073-1

Cited by 25 publications

(9 citation statements)

References 36 publications

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“…Multiple time-related classifications were described in the literature that subdivide FRI into discrete groupings such as acute and chronic infections, or early, delayed and late onset infections [105–107]. …”

Section: Discussionmentioning

confidence: 99%

Insights into treatment and outcome of fracture-related infection: a systematic literature review

Bezstarosti

Lieshout

Voskamp

et al. 2018

Arch Orthop Trauma Surg

112

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IntroductionStandardized guidelines for treatment of fracture-related infection (FRI) are lacking. Worldwide many treatment protocols are used with variable success rates. Awareness on the need of standardized, evidence-based guidelines has increased in recent years. This systematic literature review gives an overview of available diagnostic criteria, classifications, treatment protocols, and related outcome measurements for surgically treated FRI patients.MethodsA comprehensive search was performed in all scientific literature since 1990. Studies in English that described surgical patient series for treatment of FRI were included. Data were collected on diagnostic criteria for FRI, classifications used, surgical treatments, follow-up protocols, and overall outcome. A systematic review was performed according to the PRISMA statement. Proportions and weighted means were calculated.ResultsThe search yielded 2051 studies. Ninety-three studies were suitable for inclusion, describing 3701 patients (3711 fractures) with complex FRI. The population consisted predominantly of male patients (77%), with the tibia being the most commonly affected bone (64%), and a mean of three previous operations per patient. Forty-three (46%) studies described FRI at one specific location. Only one study (1%) used a standardized definition for infection. A total of nine different classifications were used to guide treatment protocols, of which Cierny and Mader was used most often (36%). Eighteen (19%) studies used a one-stage, 50 (54%) a two-stage, and seven (8%) a three-stage surgical treatment protocol. Ten studies (11%) used mixed protocols. Antibiotic protocols varied widely between studies. A multidisciplinary approach was mentioned in only 12 (13%) studies.ConclusionsThis extensive literature review shows a lack of standardized guidelines with respect to diagnosis and treatment of FRI, which mimics the situation for prosthetic joint infection identified many years ago. Internationally accepted guidelines are urgently required to improve the quality of care for patients suffering from this significant complication.

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Section: Discussionmentioning

confidence: 99%

Insights into treatment and outcome of fracture-related infection: a systematic literature review

Bezstarosti

Lieshout

Voskamp

et al. 2018

Arch Orthop Trauma Surg

112

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“…White blood cell count (WBC) with differential and neutrophil count display low sensitivity and specificity for diagnosing IFF [26,39]. Persistent elevation or a secondary rise in C-reactive protein (CRP) can be an indicator for IFF [40,41].…”

Section: Laboratory Examinationmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) is the method of choice to evaluate soft-tissue involvement and gives additional information about intramedullary infection manifestation [39]. However in cases of IFF, metal artefacts impair correct evaluation and scarring or edema in postoperative/posttraumatic bone defects may mimic an infection [68].…”

Section: Imagingmentioning

confidence: 99%

“…Since these physiological changes are also involved in fracture healing, it cannot discriminate between infection and posttraumatic bone formation. Therefore, bone scintigraphy has limited value in the diagnosis of IFF [26,39,70]. WBC imaging, using in vitro labeled leucocytes is a promising technique to identify bacterial infections, but is not routinely available due to complex in vitro labeling [70].…”

Section: Imagingmentioning

confidence: 99%

“…In the majority of early infections retention and antibiotic therapy is the best option [26], but there are indications where exchanging the implant should be taken into account [26,39,119]. The factors are listed in Table IV.…”

Section: Stage-dependent Surgical Treatment Considerationsmentioning

confidence: 99%

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Infection after fracture fixation: Current surgical and microbiological concepts

Metsemakers

Kuehl

Moriarty

et al. 2018

Injury

409

368

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One of the most challenging complications in trauma surgery is infection after fracture fixation (IAFF). IAFF may result in permanent functional loss or even amputation of the affected limb in patients who may otherwise be expected to achieve complete, uneventful healing. Over the past decades, the problem of implant related bone infections has garnered increasing attention both in the clinical as well as preclinical arenas; however this has primarily been focused upon prosthetic joint infection (PJI), rather than on IAFF. Although IAFF shares many similarities with PJI, there are numerous critical differences in many facets including prevention, diagnosis and treatment. Admittedly, extrapolating data from PJI research to IAFF has been of value to the trauma surgeon, but we should also be aware of the unique challenges posed by IAFF that may not be accounted for in the PJI literature. This review summarizes the clinical approaches towards the diagnosis and treatment of IAFF with an emphasis on the unique aspects of fracture care that distinguish IAFF from PJI. Finally, recent developments in anti-infective technologies that may be particularly suitable or applicable for trauma patients in the future will be briefly discussed.

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