title: Infection in Orthopaedics.
abstract: Infection in orthopaedic trauma patients is a common problem associated with significant financial and psychosocial costs, and increased morbidity. This review outlines technologies to diagnose and prevent orthopaedic infection, examines implant-related infection and its management, and discusses the treatment of post-traumatic osteomyelitis. The gold standard for diagnosing infection has a number of disadvantages, and thus new technologies to diagnose infection are being explored, including multilocus polymerase chain reaction with electrospray ionization-mass spectrometry and optical imaging. Numerous strategies have been employed to prevent orthopaedic infection, including use of antibiotic-impregnated implant coatings and cement; however, further research is required to optimize these technologies. Biofilm formation on orthopaedic implants is attributed to the glycocalyx-mediated surface mode of bacterial growth and is usually treated through a secondary surgery involving irrigation, debridement and the appropriate use of antibiotics, or complete removal of the infected implant. Research into the treatment of post-traumatic osteomyelitis has focused on developing an optimal local antibiotic delivery vehicle, such as antibiotic-impregnated polymethylmethacrylate (PMMA) cement beads or bioabsorbable bone substitute (BBS) delivery systems. As these new technologies to diagnose, prevent and treat orthopaedic infection advance, the incidence of infection will decrease and patient care will be optimized.
authors.affiliation: *Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; †Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada; ‡The CORE Institute, Southfield, MI; §Detroit Medical Center-Providence Hospital Residency Program, Detroit, MI; ‖Department of Biomedical Engineering, Wayne State University, Detroit, MI; ¶Orthopaedic Trauma Institute, Navicent MC, Macon, GA; **Department of Orthopaedic Surgery, Mercer University Medical School, Macon, GA; and ††University of Toronto, Toronto, ON, Canada.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Cook
authors.forename: David C
authors.initials: DC
authors.lastname: Markel
authors.forename: Weiping
authors.initials: W
authors.lastname: Ren
authors.forename: Lawrence X
authors.initials: LX
authors.lastname: Webb
authors.forename: Michael D
authors.initials: MD
authors.lastname: McKee
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D010019:Osteomyelitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents