title: [Infected osteosynthesis].
abstract: BACKGROUND
  Infections after osteosynthesis are a feared complication of the surgical treatment of fractures and should be dealt with by a multidisciplinary team. In addition to the surgeon, also included in this multidisciplinary team are a specialist for infectious diseases, a microbiologist, a radiologist and often a plastic surgeon. This review article describes the current knowledge on the pathogenesis, diagnostics, classification and treatment. The aim is to demonstrate some basic rules in the treatment of infections associated with implants and to show potential therpeutic approaches.
  
  
  METHODS
  The principles of diagnostics and combined surgical and antibiotic treatment are presented based on the current specialist literature.
  
  
  RESULTS
  With the help of a team approach the goals of treatment of an infected osteosynthesis, i.e. fracture healing, return to function and eradication of infection can be achieved. While the osteosynthesis material can usually be retained in acute infections, it is better to remove the infected hardware in chronic infections as eradication of the mature biofilm is no longer possible.
  
  
  CONCLUSIONS
  With adequate local wound débridement, the use of local and systemic antibiotics, as indicated by the specialist for infectious diseases and appropriate soft tissue coverage and wound closure, acute as well as chronic infections can be successfully treated. Nowadays, the surgeon has many different options for the management of bone defects. Depending on the anatomical location and the size of the defect a variety of techniques ranging from acute shortening to the Masquelet technique up to the Ilizarov distraction technique are available. These techniques should be combined with local bactericidal treatment.
authors.affiliation: Abteilung für Traumatologie und Abteilung für Septische Chirurgie, Klinik für Orthopaedie und Traumtologie, Universitätsspital Lausanne - CHUV, Universität Lausanne, Rue du Bugnon 46, 1011, Lausanne, Schweiz. Olivier.Borens@chuv.ch.
authors.forename: O
authors.initials: O
authors.lastname: Borens
authors.affiliation: Abteilung für Orthopaedie und Traumtologie des Bewegungsapparates, Bürgerspital Solothurn, Solothurn, Schweiz.
authors.forename: N
authors.initials: N
authors.lastname: Helmy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018441:Biofilms; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D013530:Surgical Wound Infection / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Biofilm; Implants; Infection; Operative procedures