Post-traumatic osteomyelitis: an unresolved conundrum in orthopedic trauma surgery

Excerpt

The management of post-traumatic infections remains arguably one of the last frontiers in the field of orthopedic trauma surgery. Despite growing interest by specialty societies and research funding bodies, clinical innovation on the topic is hampered by inadequate risk stratification, large variability in clinical presentation, and the widespread use of “off-label” treatment strategies that lack FDA approved indications. Current diagnostic tools fall short of adequate sensitivity to allow early detection and timely management of post-traumatic osteomyelitis. For example, the use of polymerase chain reaction (PCR)-based technology allows earlier detection of microbial DNA in sonication fluid with higher sensitivity than conventional bacterial cultures, yet PCR is costly and not widely available for routine diagnostics. The need to implant foreign materials for early fracture stabilization represents an unresolved conundrum due to the vulnerability of orthopedic implants to bacterial colonization and subsequent infections. Despite advances in sterile precautions, staged damage-control protocols with scheduled “2nd look” procedures and the availability of new generation antibiotics and sophisticated microsurgical techniques for soft tissue coverage, successful strategies to prevent and mitigate post-injury infection rates remain elusive. This special issue of the European Journal of Trauma and Emergency Surgery (EJTES) is dedicated to innovations in diagnostic work-up and management strategies for post-traumatic osteomyelitis. …