Department of Orthopaedic Trauma, Vanderbilt Medical Center, Nashville, Tennessee.
Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.
J Bone Joint Surg Am. 2020 May 20;102(10):e44. doi: 10.2106/JBJS.19.01070.
Fracture-related infections (FRIs) are among the most common complications following fracture fixation, and they have a huge economic and functional impact on patients. Because consensus guidelines with respect to prevention, diagnosis, and treatment of this major complication are scarce, delegates from different countries gathered in Philadelphia in July 2018 as part of the Second International Consensus Meeting (ICM) on Musculoskeletal Infection. This paper summarizes the discussion and recommendations from that consensus meeting, using the Delphi technique, with a focus on FRIs. A standardized definition that was based on diagnostic criteria was endorsed, which will hopefully improve reporting and research on FRIs in the future. Furthermore, this paper provides a grade of evidence (strong, moderate, limited, or consensus) for strategies and practices that prevent and treat infection. The grade of evidence is based on the quality of evidence as utilized by the American Academy of Orthopaedic Surgeons. The guidelines presented herein focus not only on the appropriate use of antibiotics, but also on practices for the timing of fracture fixation, soft-tissue coverage, and bone defect and hardware management. We hope that this summary as well as the full document by the International Consensus Group are utilized by those who are charged with musculoskeletal care internationally to optimize their management strategies for the prevention and treatment of FRIs.
骨折相关感染（FRIs）是骨折固定术后最常见的并发症之一，对患者的经济和功能有重大影响。由于缺乏关于这种主要并发症的预防、诊断和治疗的共识指南，来自不同国家的代表于 2018 年 7 月在费城聚集，参加第二次国际肌肉骨骼感染共识会议（ICM）。本文使用 Delphi 技术总结了该共识会议的讨论和建议，重点是 FRIs。会议支持了一个基于诊断标准的标准化定义，希望未来能改善 FRIs 的报告和研究。此外，本文还针对预防和治疗感染的策略和实践提供了证据等级（强、中、有限或共识）。该证据等级是基于美国骨科医师学会使用的证据质量。本文提出的指南不仅关注抗生素的合理使用，还关注骨折固定、软组织覆盖以及骨缺损和硬件管理的时机等实践。我们希望，这份摘要以及国际共识小组的全文，能被负责全球肌肉骨骼护理的人员所利用，以优化 FRIs 的预防和治疗管理策略。
