Treatment of Fracture-Related Infection

Fracture-related infection is amongst the most challenging and complex conditions that physicians face all over the world. Treatment is complex and interdisciplinary, with scarce, low-quality evidence to aid decision-making. Successful management of fracture-related infection requires not only the combination of meticulous surgical treatment and pathogen-directed antimicrobial therapy, but also an in-depth understanding of the pathophysiology (including the role of biofilm), diagnostic methods, and the nuances of the advanced surgical techniques required. This book breaks down the decision-making involved in selecting and effectively performing a treatment strategy in patients with a fracture-related infection, with a keen focus on clinical relevance and applicability. Each chapter has been co-written by authors with different training (often, an orthopaedic and a plastic surgeon), as well as years of expertise in this evolving field, who present the decision-making process in an accessible way that can be immediately integrated into the physician's practice. Options for treatment are discussed based on each clinical scenario (state of the fracture, patient condition, and status of the soft tissue envelope), including indications of implant retention strategies (DAIR), amputation, options when the joint is unsalvageable (endoprosthetic replacement, arthrodesis, resection arthroplasty) or management of infected bone defects (acute shortening with or without re-lengthening, bone transport, bone grafts, bone flaps), with illustrative clinical cases at the end of the chapter. The workings and indications of the latest innovations, including molecular diagnostics, nuclear imaging, strategies to overcome resistant microorganisms, implants with antimicrobial surface modifications and compressive osseointegration, are discussed as well.
Through multidisciplinary insights and actionable, practical strategies, this book equips readers with the knowledge needed to reduce infection rates, improve patient recovery, and ultimately deliver superior care. Orthopaedic and trauma surgeons, plastic surgeons, infectious disease specialists, and other components of teams dealing with bone infections associated to fractures will find this book of great value to enhancing patient outcomes, and a direct benefit to their practice.

Nieves Vanaclocha (M.D., Ph.D., FEBOPRAS) is a distinguished plastic surgeon practicing in the Plastic Surgery and Burns Department of the University and Polytechnic Hospital La Fe in Valencia (Spain), where she is an integral member of the Orthoplastics Unit -a nationally recognised referral centre specialising in severe trauma, bone infections, and bone tumours. Her clinical expertise is centred on orthoplastics and patients with nerve injuries, with a particular focus on improving patient outcomes and enhanced recovery after surgery protocols. This includes patients with fracture-related infections, a pathology for which the existing evidence is limited, fragmented, and often presented through the perspective of a single specialty, in contrast to the clinical need for interdisciplinarity to achieve good clinical outcomes. To bridge this gap, Dr. Vanaclocha actively contributes to the field through rigorous research, lecturing at national and international conferences, and as the author of this book.