Fracture related infections.

It is a common phrase in orthopaedic trauma literature that fracture related infections are devastating complications. Still most medical professionals, let alone the general public, are not aware of the true magnitude of the problem. The orthopaedic trauma surgeons know quite well that the magical 6 weeks healing time is not applicable for the complicated fractures. An infected nonunion often take years of treatment and multiple surgeries to heal. Most people are surprised to hear that a lower limb infected nonunion is associated with such a bad quality of life it can be compared to end stage heart disease. These patients cannot mobilise and are forced to spend their lives in and out of hospital. They rely heavily on health services and often cannot generate a normal income. Besides treating this severe complication, it is also the responsibility of orthopaedic surgeons to educate other health professionals and the general public. Moreover, funding bodies, insurance companies and health policy makers should be made aware of the magnitude of this problem. In many hospitals, orthopaedic surgeons are often alone in dealing with the daunting task of treating the infection. In the absence of effective microbiological insight, their efforts are deemed futile. There is an obvious need for multidisciplinary collaborations but beyond that we have to enhance our own knowledge in microbiology, infectious diseases, pharmacology and cell biology. The Journal of Orthopaedic Surgery’s current special issue on fracture related infections and our recent published scientific papers will help our readers stay updated and stimulated about this topic. The issue explores this field from multiple angles including an overview of the magnitude of the problem and possible key factors of the outcomes and a summary of our current knowledge on the causative organisms. Three excellent treatment-focused review articles address the relevance of surgical care to the prevention and treatment of fracture related infections, the currently available highest level of evidence to guide our practice and specific aspects on the utilisation of antibiotic coated nails. As editors of the trauma section of the Journal of Orthopaedic Surgery, we believe these reviews highlight some of our recently published exciting topics such as intramedullary antibiotic perfusion, the effect of timing of debridement on outcomes after open fractures and some rare pathogen identified in non-union after closed fracture management. We hope this special issue will help our readers with their treatment as well as provide guidance in their quest for new research ideas. It is our aim that orthopaedic surgeons can think more collaboratively, and at the same time strive to promote the best management of fracture related infections in our society.