Fracture-related infections after intramedullary nailing : Diagnostics and treatment

This article gives an overview of the general principles and diagnostic criteria for FRI after nail fixation and discusses the treatment recommendations based on three case examples. In cases of acute implant infections, an implant-retaining procedure is principally possible for both periprosthetic joint infections and FRI; however, after intramedullary nailing the nail should also be exchanged in cases of acute nail infections as a sufficient debridement of the nail is impossible due to its intramedullary location. In chronic FRI after intramedullary nailing a one-stage or two-stage procedure can be followed. In cases of adequate soft tissue coverage, good fracture reduction and an expected bone healing without critical bony substance defects, a one-stage procedure with nail exchange should be preferred. If a chronic infection with soft tissue and bone defects develops after intramedullary nailing, a two-stage procedure analogous to the treatment of osteomyelitis should be considered. In this case a multidisciplinary team approach with specialists in plastic surgery, microbiology and infectious diseases is necessary. The use of local antibiotics and antimicrobial-coated implants is deemed to be advantageous.PMID:34923596 | DOI:10.1007/s00113-021-01117-0
Source: Der Unfallchirurg - Category: Orthopaedics Authors: Source Type: research