Infection can occur in the bone following a fracture by three means
- The fracture is open and wound gets infected by organism introduced from without.
- The fracture hematoma can get infected by organisms from bloodstream.
- Post surgical infection
Despite all the measures to control it, infection occurs in some open fractures and closed fractures. The incidence is higher in patients with extensive soft tissue injury.
First goal of the treatment is to prevent the infection. however, if an infection develops it should be closed. If the infection is suoperficial and limited, local toileting and antibiotics help.
However in case the infection is quite deep, the measures should be taken accordingly. Drainage of pus, debridement of local necrotic tissues, irrigation of the wound are various local measures that can be used. Antibiotics are the drugs that kill the infective organisms but not all antibiotics have same spectrum of activity.
Therefore it is very important to know what organism has infected the wound. this can be done by taking discharge or pus from the wound and culture it to grow the inhabiting organisms. After they have been grown, organisms are tested against various antibiotics to know what inhibits the growth the greatest.
This test is called culture and sensitivity and helps to administrate appropriate drugs.
Superficial infections frequently respond to this treatment alone. If the infection appears to be deep, the wound should be opened to provide drainage and then splinted accordingly with plaster or external fixator.
If internal fixation is in place and the fixation device has not loosened, it should not be removed. Majority of internally fixed fracture unite in spite of infection with antibiotic treatment and drainage. If fixation is loose, revising or removing the internal fixation and using external fixation to maintain stability and to allow dressing changes and wound care should be considered.
Other kind of infection that occur are late infection. This may cause loss of fixation and nonunion.
For late infections, when fixation has been lost and nonunion has developed an aggressive, the principle of treatment is that union of the fracture must be obtained even in the presence of infection. Implant removal and including removal of necrotic and infected diaphyseal bone should be done as these would contribute to the infection. The loss of bone resulted can be filled with graft.
The wound needs to be examined regularly to perform bone grafting at an appropriate time.
In spite of these measures a few patients go into chronic infection which is even more difficult to manage.
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