{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:06:37Z","timestamp":1786579597907,"version":"build-2736575974"},"reference-count":132,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Nonunions and fracture-related infections represent a significant complication in orthopedic and trauma care, with their incidence rising due to an aging, more comorbid global population and the escalating threat of multi-resistant pathogens. This narrative review highlights pivotal advancements in diagnostics and therapeutic approaches, while also providing an outlook on future directions. Diagnostic methodologies have significantly evolved from traditional cultures to sophisticated molecular techniques like metagenomic next-generation sequencing and advanced imaging. Simultaneously, therapeutic strategies have undergone substantial refinement, encompassing orthoplastic management for infected open fractures and the innovative application of antibiotic-loaded bone substitutes for local drug delivery. The effective integration of these possibilities into daily patient care critically depends on specialized centers. These institutions play an indispensable role in managing complex cases and fostering innovation. Despite considerable progress over the past 25 years, ongoing research, interdisciplinary collaboration, and a steadfast commitment to evidence-based practice remain crucial to transforming management for the future.<\/jats:p>","DOI":"10.3390\/jcm14217767","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T19:30:27Z","timestamp":1762198227000},"page":"7767","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Managing Nonunions and Fracture-Related Infections\u2014A Quarter Century of Knowledge, and Still Curious: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2486-665X","authenticated-orcid":false,"given":"Jonas","family":"Armbruster","sequence":"first","affiliation":[{"name":"BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4185-178X","authenticated-orcid":false,"given":"Benjamin","family":"Thomas","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen, Department of Hand, Plastic, and Reconstructive Surgery, Burn Center at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Stengel","sequence":"additional","affiliation":[{"name":"BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Leipziger Pl. 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"Spranger","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, 12683 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0730-4782","authenticated-orcid":false,"given":"Paul Alfred","family":"Gruetzner","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5668-8831","authenticated-orcid":false,"given":"Simon","family":"Hackl","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, BG Unfallklinik Murnau, Professor-K\u00fcntscher-Stra\u00dfe 8, 82418 Murnau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/S0140-6736(16)31592-6","article-title":"Progress in Evidence-Based Medicine: A Quarter Century on","volume":"390","author":"Djulbegovic","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Armbruster, J., Bussmann, F., Freischmidt, H., Reiter, G., Gruetzner, P.A., and El Barbari, J.S. 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