, G. Muthukrishnan 2, J.L. Daiss 1, C. Xie 2, K. Nishitani 1, Y. Morita 2, H. Awad 2, K.L. de Mesy Bentley 2, E. Masters 2, T. Bui 2, M. Yan 2, J. Owen 3, B. Mooney 2, S. Gill 2, J. Puetzler 4, J.C. Wenke 5, M. Morgenstern 6, W-J. Metsemakers 7,10, C. Noll 8, A. Joeris 9, R.G. Richards 1, E.M. Schwarz 2, S.L. Kates 31 AO Research Institute Davos, Davos, Switzerland
2 Center for Musculoskeletal Research, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
3 Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
4 Clinic for General and Tumour Orthopaedics, University Hospital Muenster, Muenster, Germany
5 Orthopaedic Trauma Research Department, U.S. Army Institute of Surgical Research, San Antonio, TX, USA
6 Center for Musculoskeletal Infections, Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
7 Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
8 Institute of Medical Microbiology, University Medical Center Göttingen, Göttingen, Germany
9 AO Innovation Translation Center, AO Foundation, Dübendorf, Switzerland
10 KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium
Abstract
Bone infection has received increasing attention in recent years as one of the main outstanding clinical problems in orthopaedic-trauma surgery that has not been successfully addressed. In fact, infection may develop across a spectrum of patient types regardless of the level of perioperative management, including antibiotic prophylaxis. Some of the main unknown factors that may be involved, and the main targets for future intervention, include more accurate and less invasive diagnostic options, more thorough and accurate debridement protocols, and more potent and targeted antimicrobials. The underlying biology dominates the clinical management of bone infections, with features such as biofilm formation, osteolysis and vascularisation being particularly influential. Based on the persistence of this problem, an improved understanding of the basic biology is deemed necessary to enable innovation in the field. Furthermore, from the clinical side, better evidence, documentation and outreach will be required to translate these innovations to the patient. This review presents the findings and progress of the AO Trauma Clinical Priority Program on the topic of bone infection.
Graphical Abstract
