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infections are typically due to less virulent bacteria, such as Staphylococcus epidermidis or Cutibacterium acnes. 4 In this situation the biofilm is mature and more resistant to antibiotic therapy. Patients with delayed infections can present with
Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
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Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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rates ranging from 3 to 26%, with a cumulative incidence of 9.9% ( 58 ). Proper wound cleansing and debridement are important for open fractures, as is proper antibiotic therapy. There is no universal protocol on which antibiotics to use or on the
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assessment, intravenous antibiotic therapy, and surgical treatment as deemed necessary. Most studies concern septic arthritis in the adult native knee joint. But, as occurs in other joints (shoulder, sternoclavicular or wrist), bacterial arthritis of the
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recurrent disease is complex and resource-intensive, often requiring multiple surgical interventions and extended periods of antibiotic therapy. A number of authors have reported unique treatment strategies. For example, Kanakaris et al describe use of a
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Children’s Orthopaedic Surgery (BSCOS) guidelines recommend that microbiology specimens be taken prior to antibiotic therapy administration but state that this should not delay treatment in unwell children. 29 Samples should be sent for urgent
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different concentrations. For systemic antibiotic therapy, information on the typical tissue concentrations reached with standard antibiotic doses is integrated with the minimal inhibitory concentrations (MIC) of a pathogen to determine the MIC breakpoints
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Open fractures of the lower extremity are the most common open long bone injuries, yet their management remains a topic of debate.
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This article discusses the basic tenets of management and the subsequent impact on clinical outcome. These include the rationale for initial debridement, antimicrobial cover, addressing the soft-tissue injury and definitive skeletal management.
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The classification of injury severity continues to be a useful tool in guiding treatment and predicting outcome and prognosis. The Gustilo-Anderson classification continues to be the mainstay, but the adoption of severity scores such as the Ganga Hospital score may provide additional predictive utility.
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Recent literature has challenged the perceived need for rapid debridement within 6 hours and the rationale for prolonged antibiotic therapy in the open fracture. The choice of definitive treatment must be decided against known efficacy and injury severity/type.
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Recent data demonstrate better outcomes with internal fixation methods in most open tibial fractures, but external fixation continues to be an appropriate choice in more severe injuries. The incidence of infection and non-union has decreased with new treatment approaches but continues to be a source of significant morbidity and mortality.
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Assessment of functional outcome using various measures has been prevalent in the literature, but there is limited consensus regarding the best measures to be used.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170072
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(radical debridement, revision surgery and prolonged antibiotic therapy) often result in significant socioeconomic costs, not to mention the risk of life-long functional impairment for the patient. Against this background, and with the increasing issue of
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reported factors associated with successful single-stage exchange as gram-positive organism, absence of sinus tract, aggressive debridement of infected tissue, antibiotics-impregnated cement and long-term antibiotic therapy, whereas rheumatoid arthritis and
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-fold of the minimal-inhibiting concentrations (MIC), biofilm embedded pathogens up to 1000-fold MIC for elimination 31 and these are usually not possible for systemic antibiotic therapy as well as for antibiotics released from PMMA. 32 In
