Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Infection. 2020 Jun;48(3):333-344. doi: 10.1007/s15010-020-01418-3. Epub 2020 Apr 8.
The current treatment concepts of fracture-related infection (FRI) [Consensus Conference (Anti-Infection Task Force (AITF)) on the definition of acute or chronic osteomyelitis (cOM)] are associated with unsolved challenges and problems, underlining the need for ongoing medical research.
Literature review of treatments for FRI and description of own cases.
We could include eight papers with 394 patients reporting treatments and outcome in FRI. The infection was resolved in 92.9% (mean) of all treatments. The mean follow-up was 25 months with a persistent non-union in 7% of the patients. We diagnosed 35 (19f/16m; 56.4 ± 18.6 years) patients with bone infections anatomically allocated to the proximal and distal femur (12×), the pelvis (2×), distal tibia (3×), tibial diaphysis (11×), the ankle joint (4×) and calcaneus (3×). These 35 patients were treated (1) with surgical debridement; (2) with antibiotic-eluting ceramic bone substitutes; (3) bone stabilization (including nail fixation, arthrodesis nails, plates, or external ring fixation), (4) optionally negative pressure wound therapy (NPWT) and (5) optionally soft tissue closure with local or free flaps. The mean follow-up time was 14.9 ± 10.6 months (min/max: 2/40 month). The overall recurrence rate is low (8.5%, 3/35). Prolonged wound secretion was observed in six cases (17.1%, 6/35). The overall number of surgeries was a median of 2.5.
The results in the literature and in our case series are explicitly promising regarding the treatment of posttraumatic fracture-related infection.
骨折相关感染（FRI）[关于急性或慢性骨髓炎（cOM）定义的共识会议（抗感染工作组（AITF））]的当前治疗概念存在尚未解决的挑战和问题，这凸显了持续进行医学研究的必要性。
对 FRI 治疗方法的文献回顾，并描述自身病例。
我们纳入了 8 篇文献，其中有 394 例患者报告了 FRI 的治疗和结果。所有治疗中，感染的治愈率为 92.9%（平均值）。平均随访时间为 25 个月，患者中有 7%持续存在非愈合。我们诊断了 35 名（19 名女性/16 名男性；56.4±18.6 岁）解剖学上位于股骨近端和远端（12 例）、骨盆（2 例）、胫骨远端（3 例）、胫骨骨干（11 例）、踝关节（4 例）和跟骨（3 例）的骨感染者。这些 35 名患者接受了以下治疗：（1）手术清创术；（2）使用抗生素洗脱陶瓷骨替代物；（3）骨稳定术（包括钉固定、关节融合钉、钢板或外固定架固定）；（4）选择性负压伤口治疗（NPWT）；（5）选择性使用局部或游离皮瓣进行软组织闭合。平均随访时间为 14.9±10.6 个月（最小/最大：2/40 个月）。总体复发率较低（8.5%，3/35）。6 例（17.1%，6/35）出现迁延性伤口分泌物。总的手术次数中位数为 2.5 次。
文献和我们的病例系列中关于创伤后骨折相关感染的治疗结果明确有希望。
