Fracture-Related Infection and the Complexity of Bone Defect Reconstruction

Fracture-related infection (FRI) is a major complication related to musculoskeletal injuries that not only has important clinical consequences, but also a substantial socioeconomic impact (1). Adequate debridement of non-viable bone remains one of the cornerstones of the management of FRI. This debridement, along with the bone loss that occurs at time of the initial trauma and due to the infectious process itself, frequently results in the presence of significant bone defects. These so-called infected bone defects after trauma remain a challenging problem for orthopedic trauma surgeons. Currently, the optimal management of these bone defects remains controversial (2). Many authors already highlighted the lack of standardization in the management algorithms of infected bone defect reconstructions (3). Multiple individual treatment protocols exist, e.g., cancellous grafts with or without the use of local antibiotics, the induced membrane technique, the use of vascularized grafts, or the Ilizarov bone transport technique with or without the use of local antibiotics (2). The success of bone defect reconstruction in FRI cases depends on various factors, including the severity of the infection, the patient's immune response, and the quality of care received. Today, collaborative multidisciplinary efforts remain key to address these sometimes extremely difficult clinical problems.