Bone Infection Following Treatment for Open Fracture Injuries

            Open fractures create “the perfect storm” for infection to complicate injury:  the initial wound is contaminated and injury to soft tissues potentiates an on going exposure to pathogens (bacteria); surgical implants (plates, screws and rods) and dead bone fragments grant ‘safe-haven’ to proliferating microbes; ischemia, dead space and foreign bodies impede local immunity and the delivery of antibiotics; shock, crush-injury and pre-existing health conditions compromise the host response.    As a result, osteomyelitis (bone infection) and fracture non-union are the most common complications following treatment for open fractures.  Once a bone infection is diagnosed, the goals of treatment are three-fold:  timely intervention; creation and maintenance of a live, clean, manageable wound; adequate and durable fracture fixation.   

Strategies to Minimize Complications:

1) After treatment for an open fracture, follow patients closely: culture all wound drainage; serially check CBC, ESR and CRP values; manage wound-healing disturbances aggressively, especially in compromised hosts (B-hosts).  

2) Treat the bone infection as either an ‘early’ or a ‘late’ process, based on the time lapsed since index-contamination (early < 4weeks).   http://www.osteomyelitis.com/pdf/treatment_protocol.pdf

3) Base antimicrobial therapy on multiple tissue specimens and pathogen sensitivities and use bactericidal antibiotics whenever possible.

4) Reverse all amenable, host co-morbidities and optimize the host response throughout treatment. http://www.osteomyelitis.com/pdf/staging-paper.pdf

5)  Select ‘low-risk’ methods when treating ‘high-risk’ patients ( see  Cierny III, G., DiPasquale, D. Treatment of Chronic Infection. in the Symposium: Extremity War Injuries: state of the art and future directions. JAAOS , Vol 14, No. 10, 105-110, October 2006.