Articles | Volume 8, issue 2
https://doi.org/10.5194/jbji-8-133-2023
© Author(s) 2023. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-8-133-2023
© Author(s) 2023. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Diagnosis of fracture-related infection in patients without clinical confirmatory criteria: an international retrospective cohort study
Niels Vanvelk
Trauma Research Unit, Department of Surgery, Erasmus MC, University
Medical Centre Rotterdam, Rotterdam, the Netherlands
Esther M. M. Van Lieshout
Trauma Research Unit, Department of Surgery, Erasmus MC, University
Medical Centre Rotterdam, Rotterdam, the Netherlands
Jolien Onsea
Department of Trauma Surgery, University Hospitals Leuven, Leuven,
Belgium
Department of Development and Regeneration, KU Leuven, Leuven, Belgium
Jonathan Sliepen
Department of Trauma Surgery, University Medical Centre Groningen,
Groningen, the Netherlands
Geertje Govaert
Department of Trauma Surgery, University Medical Centre Utrecht,
Utrecht, the Netherlands
Frank F. A. IJpma
Department of Trauma Surgery, University Medical Centre Groningen,
Groningen, the Netherlands
Melissa Depypere
Department of laboratory medicine, University Hospitals Leuven,
Leuven, Belgium
Department of Microbiology, Immunology and Transplantation, Laboratory
of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
Jamie Ferguson
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford
University Hospitals, Oxford, UK
Martin McNally
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford
University Hospitals, Oxford, UK
William T. Obremskey
Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt
University Medical Center, Nashville, Tennessee, USA
Charalampos Zalavras
Department of Orthopaedic Surgery, Keck School of Medicine,
University of Southern California, Los Angeles, USA
Michael H. J. Verhofstad
Trauma Research Unit, Department of Surgery, Erasmus MC, University
Medical Centre Rotterdam, Rotterdam, the Netherlands
Willem-Jan Metsemakers
CORRESPONDING AUTHOR
Department of Trauma Surgery, University Hospitals Leuven, Leuven,
Belgium
Department of Development and Regeneration, KU Leuven, Leuven, Belgium
Related authors
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Baixing Chen, T. Fintan Moriarty, Hans Steenackers, Georges F. Vles, Jolien Onsea, Thijs Vackier, Isabel Spriet, Rob Lavigne, R. Geoff Richards, and Willem-Jan Metsemakers
J. Bone Joint Infect., 9, 249–260, https://doi.org/10.5194/jbji-9-249-2024, https://doi.org/10.5194/jbji-9-249-2024, 2024
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Our research explores natural antimicrobials to combat orthopedic-device-related infections, a challenging issue due to antibiotic resistance. We reviewed agents from bacteria, fungi, viruses, animals, plants and minerals, evaluating their effectiveness and synergy with traditional antibiotics. Our findings suggest these natural alternatives could revolutionize infection management in orthopedic patients, offering new hope for reducing antibiotic resistance and improving treatment outcomes.
Fred Ruythooren, Stijn Ghijselings, Melissa Depypere, Willem-Jan Metsemakers, Liesbet Henckaerts, Nathalie Noppe, and Georges Vles
J. Bone Joint Infect., 9, 167–171, https://doi.org/10.5194/jbji-9-167-2024, https://doi.org/10.5194/jbji-9-167-2024, 2024
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The article examines a unique case of Ureaplasma urealyticum causing osteomyelitis in the greater trochanter of a 26-year-old male treated with ocrelizumab for multiple sclerosis. It emphasizes the necessity of a multidisciplinary approach and advanced PCR diagnostics to manage such rare opportunistic infections effectively, highlighting the challenges faced due to the immunosuppressive nature of monoclonal antibody therapies of this kind.
Jordi Cools, Stijn Ghijselings, Fred Ruythooren, Sander Jentjens, Nathalie Noppe, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 9, 27–35, https://doi.org/10.5194/jbji-9-27-2024, https://doi.org/10.5194/jbji-9-27-2024, 2024
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Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency. To date, the role of advanced imaging has been confined to supporting or opposing diagnosis; however, implications for surgical decision-making and outcomes have not yet been established. We found that extra-articular abscesses are present in two out of three patients and require varying anatomical approaches. Therefore, we recommend routinely performing advanced imaging in all adults with SA of the native hip joint.
Fred Ruythooren, Stijn Ghijselings, Jordi Cools, Melissa Depypere, Paul De Munter, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 8, 209–218, https://doi.org/10.5194/jbji-8-209-2023, https://doi.org/10.5194/jbji-8-209-2023, 2023
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A total of 41 patients who underwent surgical treatment for septic arthritis (SA) of the native hip were studied. We show that patients with SA of the native hip can be divided in three distinct clinical subgroups based on route of infection. Route of infection is directly related to the chance of femoral head preservation and should, therefore, be the basis for decision-making. Only patients with blood-borne infections in an undamaged hip had a reasonable chance of femoral head preservation.
Asanka Wijendra, Alex Ramsden, and Martin McNally
J. Bone Joint Infect., 8, 183–188, https://doi.org/10.5194/jbji-8-183-2023, https://doi.org/10.5194/jbji-8-183-2023, 2023
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Cancerous transformation is a rare but potentially life-threatening complication of chronic bone infection. As with all forms of cancer, early detection and diagnosis is crucial to outcome.
Whilst there have been over 100 cases of chronic bone infection with cancerous transformation reported in the literature between 1999 and 2020, this is the first case report to document transformation with 20 years of concordant imaging and clinical review.
Maria Dudareva, Andrew Hotchen, Martin A. McNally, Jamie Hartmann-Boyce, Matthew Scarborough, and Gary Collins
J. Bone Joint Infect., 6, 257–271, https://doi.org/10.5194/jbji-6-257-2021, https://doi.org/10.5194/jbji-6-257-2021, 2021
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Clinical prognostic models are tools that predict treatment outcomes for individual patients. For adults with bone and joint infection treated with surgery and implant removal, this review found no existing unbiased clinical prediction models that took modifiable health factors into account to estimate prognosis. Developing a clinical prognostic model may help treatment decisions and future targeted research in orthopaedic infection.
Martin McNally
J. Bone Joint Infect., 6, 199–201, https://doi.org/10.5194/jbji-6-199-2021, https://doi.org/10.5194/jbji-6-199-2021, 2021
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This paper provides further evidence that treatment of osteomyelitis by serial debridement without the use of local antimicrobials has high recurrence rates (20 %–30 %). The addition of bioglass did not improve this compared to using bone graft alone. Additional systemic antibiotic was required in many cases, increasing the risk of antimicrobial resistance. Recent series of single-stage surgery with local antibiotic delivery have reported better outcomes.
Jamie Ferguson, Myriam Alexander, Stuart Bruce, Matthew O'Connell, Sue Beecroft, and Martin McNally
J. Bone Joint Infect., 6, 151–163, https://doi.org/10.5194/jbji-6-151-2021, https://doi.org/10.5194/jbji-6-151-2021, 2021
Martina Galea Wismayer, Kurstein Sant, Ryan Giordmaina, and Martin McNally
J. Bone Joint Infect., 6, 141–145, https://doi.org/10.5194/jbji-6-141-2021, https://doi.org/10.5194/jbji-6-141-2021, 2021
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We report the treatment of bone infection in a patient with a rare disease which causes overgrowth of the limb. Careful assessment of the scans showed that the infection was in some new bone which had formed in the soft tissues after a minor injury to the leg and not in one of the major bones. This made treatment much easier with a successful outcome.
Max Mifsud, Jamie Y. Ferguson, David A. Stubbs, Alex J. Ramsden, and Martin A. McNally
J. Bone Joint Infect., 6, 63–72, https://doi.org/10.5194/jbji-6-63-2020, https://doi.org/10.5194/jbji-6-63-2020, 2020
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Chronic bone infections often present with major bone and soft tissue loss which can be difficult to manage. In this study, we treated the most complex infections using surgery which reconstructed all of the tissues in one operation.
We showed that this was a safe approach with very good outcomes. All of the bones healed and 96.5 % of patients were infection-free at final follow-up. This type of surgery requires close cooperation of a multidisciplinary team with expertise in major infections.
Related subject area
Subject: Fracture-related infections | Topic: All topics
The antibiotic bead pouch – a useful technique for temporary soft tissue coverage, infection prevention and therapy in trauma surgery
Infection complicating locked intramedullary nailing of open lower-extremity fractures: incidence, associated risk factors, and lessons for improving outcome in a low-resource setting
Candida fracture-related infection: a systematic review
Markus Rupp, Nike Walter, Dominik Szymski, Christian Taeger, Martin Franz Langer, and Volker Alt
J. Bone Joint Infect., 8, 165–173, https://doi.org/10.5194/jbji-8-165-2023, https://doi.org/10.5194/jbji-8-165-2023, 2023
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The antibiotic bead pouch is a useful technique for temporary soft tissue coverage. After the introduction of negative wound pressure therapy, it has fallen into oblivion. However, the technique has several advantages, which are highlighted in the present review article. After debridement, the antibiotic beads deliver high dosages of antibiotics suitable for bone cements. This enables a sterile wound, which might help to avoid either infection or progress of infection.
Stephen A. Adesina, Isaac O. Amole, Akinsola I. Akinwumi, Adepeju O. Adegoke, James I. Owolabi, Imri G. Adefokun, Adewumi O. Durodola, Olufemi T. Awotunde, and Samuel U. Eyesan
J. Bone Joint Infect., 8, 71–79, https://doi.org/10.5194/jbji-8-71-2023, https://doi.org/10.5194/jbji-8-71-2023, 2023
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In a low-resource setting, we studied the risk factors for infection in 101 open fractures treated with the SIGN nail. We found that infection of fractures increased with fracture severity. The treatment-related factors found to have significant association with infection were also essentially the same as those known in advanced countries. We believe low-resource settings could affordably adopt management approaches of high-income countries to achieve good outcomes despite the scarce resources.
Daniele De Meo, Gianluca Cera, Giancarlo Ceccarelli, Valerio Castagna, Raissa Aronica, Edoardo M. Pieracci, Pietro Persiani, and Ciro Villani
J. Bone Joint Infect., 6, 321–328, https://doi.org/10.5194/jbji-6-321-2021, https://doi.org/10.5194/jbji-6-321-2021, 2021
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The aim of this study is to summarize and improve knowledge regarding fracture-related infection caused by Candida (CFRI) through a systematic review on the topic, accompanied by a case report. Candida infections in fractures are rare but difficult-to-treat events. The existing fracture-related infection treatment algorithm combined with long-term systemic antifungal therapy has an anecdotal value and needs more extensive studies to be validated.
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Short summary
This international retrospective cohort study displays the diagnostic characteristics of 609 patients who were treated for fracture-related infection (FRI). Clinical confirmatory criteria were present in 77% of patients. In the remaining patients, the decision to operatively collect deep tissue cultures had to be based on a set of suggestive criteria. The combined use of these suggestive criteria should guide treating physicians in the management pathway of FRI.
This international retrospective cohort study displays the diagnostic characteristics of 609...