Management of Orthopaedic Infections: A Practical Guide

Description

An evidence-based resource for effectively managing challenging orthopaedic infections Orthopaedic infections represent common, potentially devastating, and sometimes fatal complications that can occur after any surgery. Infections associated with orthopaedic trauma are especially prevalent, and there is an increasing incidence of bone infections linked to a greater number of joint arthroplasties being performed annually. Management of Orthopaedic Infections: A Practical Guide by renowned orthopaedic surgeon and researcher Antonia Chen is a practical clinical reference to assist clinicians in the diagnosis and treatment of challenging infections spanning the entire orthopaedic specialty. The step-by-step guide covers frequent organisms found in orthopaedics, molecular methods to improve organism determination, different antibiotic formulations to treat infections, various irrigation solutions used during surgery, and surgical dressings. Ten concise chapters cover surgical management of common infectious pathologies, including osteomyelitis, septic joint, periprosthetic joint infection, open fractures and infected nonunions, spine infections, and graft infections. Key Features High-quality figures and instructional surgical videos illustrate and enhance understanding of important conceptsMultiple tables provide quick references and easy access to salient information needed to manage the care of patients with orthopaedic infectionsPractical tips from clinicians with vast expertise inform optimal treatment strategies and enable improved outcomes This is a must-have pocket resource for medical students, residents, fellows, and practitioners in orthopaedic surgery, as well as allied health personnel. This book includes complimentary access to a digital copy on https://medone.thieme.com. Management of Orthopaedic Infections: A Practical Guide MedOne Access Information Title Copyright Dedication Contents 1 Detection of Microbes in Orthopaedic Infections 1.1 Introduction 1.2 Culture-Based Microbiology 1.2.1 Limitations of Culture-Based Microbiology 1.2.2 Detection of Microbes in Biofilm 1.2.3 Infections with Atypical Organisms 1.2.4 Orthopaedic Hardware Infections 1.2.5 Native Bone and Joint Infections 1.3 Molecular Techniques 1.3.1 Polymerase Chain Reaction (PCR) 1.3.2 Next-Generation Sequencing (NGS) 1.4 Conclusions 2 Antibiotics for Orthopaedic Infections 2.1 Systemic Antibiotics 2.1.1 Definitions 2.1.2 Antibiotic Selection and Administration 2.1.3 Intravenous versus Oral Antibiotics 2.2 Antiseptics 2.2.1 Povidone-Iodine 2.2.2 Chlorhexidine (Gluconate/Digluconate) 2.3 Carriers that may be Associated with Antibiotics 2.3.1 Nondegradable 2.3.2 Biodegradable 2.4 Antibiotics for Use in Carriers 2.4.1 Gentamicin/Tobramycin 2.4.2 Vancomycin 2.5 Topical Antibiotics 2.6 Treatment Failure 2.7 Collaboration between Orthopaedic Surgeons and Infectious Disease Specialists 2.8 Conclusion 3 Irrigation Solutions for Orthopaedic Infections 3.1 Acetic Acid 3.1.1 Overview of Antiseptic Agents 3.1.2 Efficacy as Surgical Wound Irrigant 3.2 Bacitracin and Polymyxin 3.2.1 Overview of Antiseptic Agent 3.2.2 Efficacy as a Surgical Wound Irrigant 3.3 Dilute Povidone-Iodine (PI) 3.3.1 Overview of Antiseptic Agent 3.3.2 Efficacy as a Surgical Wound Irrigant 3.4 Chlorhexidine 3.4.1 Overview of Antiseptic Agent 3.4.2 Efficacy as a Surgical Wound Irrigant 3.5 Sodium Hypochlorite (NaOCl) 3.5.1 Overview of Antiseptic Agent 3.5.2 Efficacy as a Surgical Wound Irrigant 3.6 Hydrogen Peroxide 3.6.1 Overview of Antiseptic Agent 3.6.2 Efficacy as a Surgical Wound Irrigant 3.7 Conclusion 4 Surgical Wound Dressings after Treating Orthopaedic Infections 4.1 Introduction 4.2 Characteristics of Optimal Surgical Dressings 4.3 Dressing Types 4.3.1 Nonocclusive and Occlusive Dressings 4.3.2 Dressing Application Tips and Tricks 4.3.3 Wound Vacuum Systems 4.4 Algorithm for Surgical Dressing Selection 4.5 Conclusion 5 Osteomyelitis 5.1 Introduction 5.2 Terminology 5.3 Classification 5.3.1 Type 1 (Medullary) 5.3.2 Type 2 (Superficial) 5.3.3 Type 3 (Localized) 5.3.4 Type 4 (Diffuse) 5.4 Diagnosis 5.4.1 Clinical Features 5.4.2 Laboratory Tests 5.4.3 Imaging 5.4.4 Microbiological Diagnosis 5.4.5 Histological Diagnosis 5.5 Diagnostic Criteria 5.6 Microbiology 5.7 Treatment of Osteomyelitis 5.7.1 General Considerations 5.7.2 Acute Osteomyelitis 5.7.3 Chronic Osteomyelitis 5.7.4 Operative Treatment 5.7.5 Tissue Sampling 5.7.6 Tissue Excision 5.7.7 Antimicrobial Therapy 5.7.8 Dead Space Management 5.7.9 Bone Stabilization 5.7.10 Soft-Tissue Coverage 5.7.11 Staging of Surgery 5.8 Conclusion 6 Treatment of the Septic Native Joint 6.1 Introduction 6.2 Diagnosis 6.2.1 Risk Factors 6.2.2 Joint Involvement 6.2.3 Clinical Manifestations 6.2.4 Serum Evaluation 6.2.5 Synovial Analysis 6.2.6 Imaging 6.3 Treatment 6.3.1 Common Organisms 6.3.2 Gonococcal Arthritis 6.3.3 Other Pathogens 6.3.4 Antimicrobial Therapy 6.3.5 Surgical Treatment 6.3.6 Needle Aspiration 6.3.7 Arthroscopic Treatment 6.3.8 Open Treatment 6.4 Conclusion 7 Management of Periprosthetic Joint Infection 7.1 Introduction 7.2 Chronicity of Infection 7.3 Antibiotic Management Alone 7.4 Irrigation and Debridement 7.4.1 Irrigation and Debridement without Polyethylene Exchange 7.5 DAIR 7.6 One-Stage Exchange Arthroplasty 7.6.1 Preparation 7.6.2 Debridement 7.6.3 Temporary Closure 7.6.4 New Prosthesis Implantation 7.6.5 Outcomes of One-Stage Exchange Arthroplasty 7.7 Two-Stage Exchange Arthroplasty 7.7.1 First Stage: Debridement and Antibiotic Spacer Implantation 7.7.2 Second Stage: Reimplantation 7.7.3 Outcomes of Two-Stage Exchange Arthroplasty 7.8 Salvage Procedures for PJI 7.9 Conclusion 8 Infection after Fracture Fixation and Infected Nonunions 8.1 Antibiotic Prophylaxis for Open Fractures 8.2 Diagnosis 8.2.1 Clinical Diagnosis 8.2.2 Laboratory Tests 8.3 Imaging 8.3.1 Radiography 8.3.2 Computed Tomography 8.3.3 Magnetic Resonance Imaging 8.3.4 Nuclear Medicine Studies 8.4 Microbiology 8.4.1 Cultures 8.4.2 Common Organisms 8.5 Surgical Treatment 8.5.1 Irrigation Solutions 8.5.2 Pin Tract Infections 8.5.3 Irrigation and Debridement with Hardware Retention 8.5.4 Irrigation and Debridement with Hardware Removal 8.5.5 Irrigation and Debridement and Revision Fracture Surgery—One-Stage 8.5.6 Irrigation and Debridement with Hardware Removal and Antibiotic Spacer Placement—Two-Stage 8.6 Soft-Tissue Coverage 8.7 Antibiotics 8.8 Conclusion 9 Spine Infections 9.1 Spinal Epidural Abscesses 9.1.1 Introduction and Epidemiology 9.1.2 Anatomy and Pathogenesis 9.1.3 Presentation and Diagnosis 9.1.4 Management and Surgical Decision-Making 9.1.5 Prognosis 9.2 Vertebral Osteomyelitis and Diskitis 9.2.1 Introduction and Epidemiology 9.2.2 Anatomy and Pathogenesis 9.2.3 Presentation and Diagnosis 9.2.4 Management and Surgical Decision-Making 9.2.5 Prognosis 9.3 Conclusion 10 Graft Infections 10.1 Introduction 10.2 Risk Factors for Graft Infection 10.2.1 The Effect of Graft Type on Rates of Postoperative Infection 10.3 Clinical Presentation and Management 10.3.1 Clinical Presentation 10.3.2 Laboratory Evaluation 10.3.3 Surgical Site Infection versus Intra-articular Graft Infection 10.3.4 Organisms Responsible for Graft Infection 10.4 Management of Graft Infection 10.4.1 Nonsurgical Management 10.4.2 Surgical Management of Graft Infection 10.4.3 Graft Retention 10.4.4 Hardware Retention 10.4.5 Graft Replantation 10.4.6 Antibiotic Management 10.5 Outcomes and Complications 10.5.1 Recurrent Instability and Reoperation 10.5.2 Patient Reported Outcomes Following Graft Infection 10.5.3 Graft Infection Cost 10.6 Graft Infection Prevention 10.6.1 Intraoperative Graft Antibiotics 10.7 Intraoperative Autograft Contamination 10.8 Conclusion Index Additional MedOne Access Information