Approach to managing infection of fracture fixation devices

Similar principles to those that apply to infections involving arthroplasty devices also apply to the management of infections involving fracture fixation devices (intramedullary nails, and pins, plates and screws).

After thorough debridement of infected and compromised soft tissue and bone, it is essential that the infected fracture is mechanically stabilised to aid infection control, as well as progression to bony union.

Antibiotic choice depends on the susceptibility of the pathogen identified in aspirates or biopsy samples. Continue antibiotics until fracture union (usually 3 to 6 months). Once fracture union is achieved, consider elective removal of internal or definitive ring fixation. If infection recurs after antibiotic therapy is stopped, remaining internal fixation should be removed and an additional 6 weeks of antibiotics given.