This 2006 narrative review by Trampuz and Zimmerli covers pathogenesis, classification, diagnosis, and treatment of infections complicating fracture-fixation devices. It addresses intramedullary nails, external-fixation pins, plates, and screws, with emphasis on how biofilm biology drives both diagnostic challenge and antimicrobial strategy.
A painful, draining, or loose fracture construct — especially with a secondary CRP rise after initial postoperative decline. Signals biofilm infection, not simple wound colonization.
When you see a stable implant with an ongoing staphylococcal infection, debridement with retention plus rifampin-based combination therapy for 3 months is the evidence-based path; the goal is fracture consolidation first, eradication second.
When the construct is unstable, the organism is MRSA or fungal, or biofilm-active antibiotics are unavailable, remove the hardware. Suppressive therapy alone will not cure the infection.
For external fixator pin-track infections, the type of fixator predicts your risk: hybrid fixators carry a 20% infection rate versus only 4% for ring fixators. Treat with pin removal and a short antibiotic course, and insert new pins at a distant site if union is incomplete.
This 2006 narrative review by Trampuz and Zimmerli covers pathogenesis, classification, diagnosis, and treatment of infections complicating fracture-fixation devices. It addresses intramedullary nails, external-fixation pins, plates, and screws, with emphasis on how biofilm biology drives both diagnostic challenge and antimicrobial strategy.
A painful, draining, or loose fracture construct — especially with a secondary CRP rise after initial postoperative decline. Signals biofilm infection, not simple wound colonization.
When you see a stable implant with an ongoing staphylococcal infection, debridement with retention plus rifampin-based combination therapy for 3 months is the evidence-based path; the goal is fracture consolidation first, eradication second.
When the construct is unstable, the organism is MRSA or fungal, or biofilm-active antibiotics are unavailable, remove the hardware. Suppressive therapy alone will not cure the infection.
For external fixator pin-track infections, the type of fixator predicts your risk: hybrid fixators carry a 20% infection rate versus only 4% for ring fixators. Treat with pin removal and a short antibiotic course, and insert new pins at a distant site if union is incomplete.