Management of Chronic Fracture-Related Infection.

Abstract

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. Overall surgical treatment paradigms depend on several critical factors, including whether the bone is united, the location of fracture-related infection, implant stability, soft-tissue status, and host fitness for undergoing surgeries. Specific surgical considerations such as the technical management of bony defects are a source of controversy and ongoing research, although there is emerging evidence that suggests bone transport methods may be the most reliable option for large bone defects. With host optimization and proper treatment, high rates of infection control can be achieved. However, relapse of infection may occur, which would add a costly burden to both the patient and society.