title: Definition of infection after fracture fixation: A systematic review of randomized controlled trials to evaluate current practice.
abstract: BACKGROUND
  One of the most challenging musculoskeletal complications in modern trauma surgery is infection after fracture fixation (IAFF). Although infections are clinically obvious in many cases, a clear definition of the term IAFF is crucial, not only for the evaluation of published research data but also for the establishment of uniform treatment concepts. The aim of this systematic review was to identify the definitions used in the scientific literature to describe infectious complications after internal fixation of fractures. The hypothesis of this study was that the majority of fracture-related literature do not define IAFF.
  
  
  METHODS
  A comprehensive search was performed in Embase, Cochrane, Google Scholar, Medline (OvidSP), PubMed publisher and Web-of-Science for randomized controlled trials (RCTs) on fracture fixation. Data were collected on the definition of infectious complications after fracture fixation used in each study. Study selection was accomplished through two phases. During the first phase, titles and abstracts were reviewed for relevance, and the full texts of relevant articles were obtained. During the second phase, full-text articles were reviewed. All definitions were literally extracted and collected in a database. Then, a classification was designed to rate the quality of the description of IAFF.
  
  
  RESULTS
  A total of 100 RCT's were identified in the search. Of 100 studies, only two (2%) cited a validated definition to describe IAFF. In 28 (28%) RCTs, the authors used a self-designed definition. In the other 70 RCTs, (70%) there was no description of a definition in the Methods section, although all of the articles described infections as an outcome parameter in the Results section.
  
  
  CONCLUSIONS
  This systematic review shows that IAFF is not defined in a large majority of the fracture-related literature. To our knowledge, this is the first study conducted with the objective to explore this important issue. The lack of a consensus definition remains a problem in current orthopedic trauma research and treatment and this void should be addressed in the near future.
authors.affiliation: Department of Trauma Surgery, University Hospitals Leuven, Belgium. Electronic address: willem-jan.metsemakers@uzleuven.be.
authors.forename: W J
authors.initials: WJ
authors.lastname: Metsemakers
authors.affiliation: Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Kortram
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Morgenstern
authors.affiliation: AO Research Institute Davos, Switzerland.
authors.forename: T F
authors.initials: TF
authors.lastname: Moriarty
authors.affiliation: Department of Trauma Surgery, University Hospitals Leuven, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Meex
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Kuehl
authors.affiliation: Department of Trauma Surgery, University Hospitals Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Nijs
authors.affiliation: AO Research Institute Davos, Switzerland.
authors.forename: R G
authors.initials: RG
authors.lastname: Richards
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Münster, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Raschke
authors.affiliation: Orthopedic Septic Surgical Unit, Department of the Locomotor Apparatus and Department of Surgery and Anaesthesiology, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Borens
authors.affiliation: Department of Orthopaedic Surgery, Virginia Commonwealth University, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Kates
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
authors.forename: C
authors.initials: C
authors.lastname: Zalavras
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University Hospital of Leeds, United Kingdom and NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
authors.forename: P V
authors.initials: PV
authors.lastname: Giannoudis
authors.affiliation: Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: M H J
authors.initials: MHJ
authors.lastname: Verhofstad
mesh_terms: D005592:Fracture Fixation / Q000009:adverse effects* / Q000379:methods; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery; D006801:Humans; D010019:Osteomyelitis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000145:classification*
keywords: Definition; Definition of infection after fracture fixation; Infection after fracture fixation; Infectious complications; Internal fracture fixation