The role of implant retention and conservative management in the management of fracture-related infection

被引:1
作者
Tsang, Shao-Ting Jerry [1 ]
Ferreira, Nando [1 ]
机构
[1] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Surg Sci, Div Orthopaed Surg, ZA-7505 Cape Town, South Africa
关键词
Fracture-related infection; Debridement; Implant retention; Conservative; Dead space management; STAPHYLOCOCCUS-AUREUS; STAGING SYSTEM; BONE; DEBRIDEMENT; DIAGNOSIS; CLASSIFICATION; PROLIFERATION; OSTEOMYELITIS; IRRIGATION; GENTAMICIN;
D O I
10.1016/j.jor.2023.11.040
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Fracture-related infection (FRI) management has advanced considerably in recent years, offering new possibilities for predictable rates of infection eradication. Debridement, antibiotics, and implant retention (DAIR) procedures have shown promise in the treatment of early FRI. This article provides an overview of the principles and indications of DAIR, including the importance of meticulous debridement and the management of dead space. The outcomes of DAIR are discussed, highlighting the range of fracture union rates reported in the literature. The role of antimicrobial suppression in optimizing host biology and facilitating surgical intervention is also explored. While further research is needed to establish optimal treatment strategies, DAIR offers a valuable treatment approach for FRI when specific criteria are met. Level of evidence: IV.
引用
收藏
页码:47 / 51
页数:5
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