{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:12:05Z","timestamp":1785391925361,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003417","name":"Deutsche Gesetzliche Unfallversicherung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Treatment guidelines for fracture nonunion differ based on the presence or absence of infection. Low\u2010grade infections without preoperative clinical signs of infection are difficult to distinguish from aseptic cases. Membrane filtration of sonication fluid (MF) has been shown to be a useful method for identifying septic nonunion. Therefore, the aim of this study was to evaluate the diagnostic value of MF in differentiating low\u2010grade infected nonunion from aseptic cases. A prospective multicenter clinical study enrolled 75 patients with femoral or tibial shaft nonunion with planned revision surgery and without clinical suspicion of infection. During revision surgery, tissue from the nonunion zone was sampled for culture and histopathology, and the implant for sonication with MF and colony forming unit (CFU) quantification. Infection was diagnosed according to the diagnostic criteria for fracture\u2010related infection. The diagnostic performance of MF CFU count was evaluated by receiver operating characteristic (ROC) curve and compared with that of tissue culture (TC), sonication fluid broth culture (SFC), and Histopathological Osteomyelitis Evaluation Score (HOES). Fifty\u2010three nonunion cases were aseptic, and 22 had a low\u2010grade infection. ROC curve had an area under the curve of 0.84. The optimal CFU cutoff to discriminate between low\u2010grade infected and aseptic nonunion was 11.1\u2009CFU\/10\u2009mL sonication fluid with 64% sensitivity and 89% specificity. SFC showed a higher sensitivity of 82% but a lower specificity of 81%. The sensitivity and specificity of TC were 77% and 96%, respectively, and those of HOES were 9% and 87%, respectively. Implementation of MF in clinical diagnostics as an adjunct to TC may improve the differential diagnosis between low\u2010grade infected nonunion and aseptic nonunion.<\/jats:p>","DOI":"10.1002\/jor.26076","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T11:41:11Z","timestamp":1742989271000},"page":"1203-1211","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Membrane Filtration of Sonication Fluid\u2014A Promising Adjunctive Method for the Diagnosis of Low\u2010Grade Infection in Presumed Aseptic Nonunion"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5989-0755","authenticated-orcid":false,"given":"Katharina","family":"Trenkwalder","sequence":"first","affiliation":[{"name":"Institute for Biomechanics BG Unfallklinik Murnau Murnau am Staffelsee Germany"},{"name":"Institute for Biomechanics Paracelsus Medical University Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Erichsen","sequence":"additional","affiliation":[{"name":"Institute for Biomechanics BG Unfallklinik Murnau Murnau am Staffelsee Germany"},{"name":"Institute for Biomechanics Paracelsus Medical University Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand","family":"Weisemann","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery BG Unfallklinik Murnau Murnau am Staffelsee Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Augat","sequence":"additional","affiliation":[{"name":"Institute for Biomechanics BG Unfallklinik Murnau Murnau am Staffelsee Germany"},{"name":"Institute for Biomechanics Paracelsus Medical University Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SAND Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Hackl","sequence":"additional","affiliation":[{"name":"Institute for Biomechanics Paracelsus Medical University Salzburg Austria"},{"name":"Department of Trauma Surgery BG Unfallklinik Murnau Murnau am Staffelsee Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"589","article-title":"Update on Non\u2010Unions 2022: Imaging Diagnostics, Classification and Treatment Algorithms","volume":"125","author":"Grunert M.","year":"2022","journal-title":"Die Unfallchirurgie"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2015.09.010"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001614"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s00402-023-05103-6","article-title":"Surprise Positive Culture Rate in the Treatment of Presumed Aseptic Long\u2010Bone Nonunion: A Systematic Review With Meta\u2010Analysis of 2397 Patients","volume":"144","author":"Wagner R. 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