{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:00:04Z","timestamp":1785128404334,"version":"3.55.0"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sternal osteomyelitis (OM), particularly in the context of late-presenting non-union following cardiothoracic surgery, remains a poorly understood and inconsistently managed condition. Delayed presentations involve established infection, sternal instability, and biofilm formation, requiring a multidisciplinary approach. BOAST guidelines for fracture-related infection (FRI) recommend a combined orthoplastic approach to manage these complex cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case series identified all patients referred to a specialist bone infection unit with delayed onset sternal OM from March 2015 to March 2025. All patients were managed through a multidisciplinary pathway involving cardiothoracic surgery, orthopaedics, plastic surgery, and microbiology. Each case involved planning through a bone infection MDT, radical debridement, multiple deep tissue sampling, removal of infected foreign material, skeletal stabilisation where indicated, definitive soft tissue reconstruction, and culture-directed antimicrobial therapy. Clinical outcomes, microbiological findings, and recurrence were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fourteen patients were included (mean age 63\u00b77\u00a0years), all with significant comorbidity burden. The interval from index cardiac surgery to definitive debridement ranged from 25 to 3,251\u00a0days. Eleven patients underwent single-stage debridement with immediate reconstruction: three required staged procedures. The most commonly isolated organisms were\u00a0\n                      <jats:italic>Staphylococcus epidermidis<\/jats:italic>\n                      \u00a0(7\/14),\u00a0\n                      <jats:italic>Cutibacterium acnes<\/jats:italic>\n                      \u00a0(5\/14), and\u00a0\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      \u00a0(4\/14); mixed infections were frequent. Mean length of stay following single-stage procedures was 10\u00b75\u00a0days. During a mean follow-up of 410\u00a0days, one patient experienced recurrence requiring further surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case series demonstrates that delayed sternal OM and non-union can be effectively managed through an orthoplastic approach aligned with FRI principles. Isolated soft tissue coverage, which has historically been the default management, fails to address the underlying pathology. Approaches focused solely on soft tissue reconstruction risk, persistent infection, and instability. This study supports the application of fracture-related infection principles to delayed sternal osteomyelitis, emphasising radical debridement, hardware removal, multidisciplinary decision-making, and definitive reconstruction as key components of successful treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-026-06916-x","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:16:19Z","timestamp":1782137779000},"page":"1653-1659","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Orthoplastic management of delayed sternal osteomyelitis and non-union: a retrospective case series applying fracture-related infection principles"],"prefix":"10.1007","volume":"50","author":[{"given":"Katie","family":"Hutchinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Banks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Lohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Trompeter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"issue":"4","key":"6916_CR1","doi-asserted-by":"publisher","first-page":"962","DOI":"10.21037\/jtd-21-1694","volume":"14","author":"YK Cha","year":"2022","unstructured":"Cha YK, Choi MS, Bak SH, Kim JS, Kim CH, Chung MJ (2022) Incidence and risk factors for sternal osteomyelitis after median sternotomy. 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