title: Infection after fracture osteosynthesis - Part II.
abstract: In the first part of this article, we have discussed the pathogenesis, clinical presentation, diagnosis and classification of infection after fracture osteosynthesis with implants, termed here as osteosynthesis-associated infection (OAI). Prolonged antibiotic treatment is usually necessary. Implant retention and maintenance of fracture stability to allow for fracture healing in spite of infection are allowed for OAI. Depending on the severity of infection, status of fracture healing and host status, the treatment follows five common pathways. These are non-operative treatment, debridement with implant retention, conversion of fixation, implant removal and suppression therapy. The decision-making process leading to each treatment pathway and challenging scenarios is discussed in detail.
authors.affiliation: 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Christian
authors.initials: C
authors.lastname: Fang
authors.affiliation: 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong.|3 Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
authors.forename: Tak-Man
authors.initials: TM
authors.lastname: Wong
authors.affiliation: 2 Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Kelvin Kw
authors.initials: KK
authors.lastname: To
authors.affiliation: 2 Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Samson Sy
authors.initials: SS
authors.lastname: Wong
authors.affiliation: 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Tak-Wing
authors.initials: TW
authors.lastname: Lau
authors.affiliation: 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong.|3 Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
authors.forename: Frankie
authors.initials: F
authors.lastname: Leung
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D020878:Device Removal / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: biofilms; fracture fixation; prosthesis-related infections; surgical wound infection