{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T18:38:21Z","timestamp":1776105501188,"version":"3.50.1"},"reference-count":49,"publisher":"Universa BV","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Orthop Belg"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:p>The concept of Debridement, Antibiotics and Implant Retention (DAIR) is well known in periprosthetic joint infections. Extrapolating this concept to fracture related infections is mired in controversies. Characteristics of the metal implant, duration of infection, state of fracture healing, microbiological profile etc. appear to play a role in the decision making process whether or not to keep, adjust , exchange or remove (infected) metalwork. More than likely it is the quality of source control by meticulous debridement having a major impact whether a DAIR approach to FRI could result in a successful outcome.<\/jats:p>","DOI":"10.52628\/90.4.12423","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T11:00:35Z","timestamp":1737975635000},"page":"691-697","source":"Crossref","is-referenced-by-count":1,"title":["Can we DAIR in FRI? Debridement techniques in osteomyelitis"],"prefix":"10.52628","volume":"90","author":[{"given":"J","family":"NEYT","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"VICTOR","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O","family":"CORNU","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"27062","published-online":{"date-parts":[[2025,1]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Fang C, Wong TM, Lau TW, To KK, Wong SS, Leung F. Infection after fracture osteosynthesis - Part I. J Orthop Surg (Hong Kong). 2017;25(1):2309499017692712.","DOI":"10.1177\/2309499017692712"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Fang C, Wong TM, To KK, Wong SS, Lau TW, Leung F. Infection after fracture osteosynthesis - Part II. J Orthop Surg (Hong Kong). 2017;25(1):2309499017692714.","DOI":"10.1177\/2309499017692714"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006;37(2):S59-S66.","DOI":"10.1016\/j.injury.2006.04.010"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Darouiche RO. Treatment of infections associated with surgical implants. New England Journal of Medicine. 2004;350(14):1422-9.","DOI":"10.1056\/NEJMra035415"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Napierala MA, Rivera JC, Burns TC, Murray CK, Wenke JC, Hsu JR, et al. Infection reduces return-to-duty rates for soldiers with Type III open tibia fractures. Journal of Trauma and Acute Care Surgery. 2014;77(3):S194-S7.","DOI":"10.1097\/ta.0000000000000364"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Mellstrand-Navarro C, Pettersson H, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. The bone & joint journal. 2014;96(7):963-9.","DOI":"10.1302\/0301-620x.96b7.33149"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Ktistakis I, Giannoudi M, Giannoudis PV. Infection rates after open tibial fractures: are they decreasing? Injury. 2014;45(7):1025-7.","DOI":"10.1016\/j.injury.2014.03.022"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Zanichelli V, Sharland M, Cappello B, Moja L, Getahun H, Pessoa-Silva C, et al. The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance. Bull World Health Organ. 2023;101(4):290-6.","DOI":"10.2471\/blt.22.288614"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"SPREAD H. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J Bone Joint Surg Am. 1976;58:453-8.","DOI":"10.2106\/00004623-197658040-00004"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Bachoura A, Guitton TG, Smith RM, Vrahas MS, Zurakowski D, Ring D. Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care. Clinical Orthopaedics and Related Research\u00ae. 2011;469:2621-30.","DOI":"10.1007\/s11999-010-1737-2"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Penn-Barwell J, Murray C, Wenke J. Early antibiotics and debridement independently reduce infection in an open fracture model. The Journal of Bone and Joint Surgery British volume. 2012;94(1):107-12.","DOI":"10.1302\/0301-620x.94b1.27026"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Soni A, Vollans S, Malhotra K, Mann C. Association between smoking and wound infection rates following calcaneal fracture fixation. Foot & Ankle Specialist. 2014;7(4):266-70.","DOI":"10.1177\/1938640014537301"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Costerton JW, Lewandowski Z, Caldwell DE, Korber DR, Lappin-Scott HM. Microbial biofilms. Annual review of microbiology. 1995;49(1):711-45.","DOI":"10.1146\/annurev.mi.49.100195.003431"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Gristina AG. Implant failure and the immuno-incompetent fibro-inflammatory zone. Clinical Orthopaedics and Related Research\u00ae. 1994;298:106-18.","DOI":"10.1097\/00003086-199401000-00016"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Schmidt AH, Swiontkowski MF. Pathophysiology of infections after internal fixation of fractures. JAAOS- Journal of the American Academy of Orthopaedic Surgeons. 2000;8(5):285-91.","DOI":"10.5435\/00124635-200009000-00002"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Rochford E, Richards R, Moriarty T. Influence of material on the development of device-associated infections. Clinical Microbiology and Infection. 2012;18(12):1162-7.","DOI":"10.1111\/j.1469-0691.2012.04002.x"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Rittmann W, Perren S, Rittmann W, Perren S. 1. Introduction and Purpose of the Experiment. Cortical Bone Healing after Internal Fixation and Infection: Biomechanics and Biology. 1974:1-3.","DOI":"10.1007\/978-3-642-65977-5_1"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Roman\u00f2 CL, Roman\u00f2 D, Logoluso N, Drago L. Bone and joint infections in adults: a comprehensive classification proposal. European orthopaedics and traumatology. 2011;1:207-17.","DOI":"10.1007\/s12570-011-0056-8"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Torbert JT, Joshi M, Moraff A, Matuszewski PE, Holmes A, Pollak AN, et al. Current bacterial speciation and antibiotic resistance in deep infections after operative fixation of fractures. Journal of orthopaedic trauma. 2015;29(1):7-17.","DOI":"10.1097\/bot.0000000000000158"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"McNally M, Corrigan R, Sliepen J, Dudareva M, Rentenaar R, IJpma F, et al. What factors affect outcome in the treatment of fracture-related infection? Antibiotics. 2022;11(7):946.","DOI":"10.3390\/antibiotics11070946"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Cierny Iii G, Mader JT, Penninck JJ. The classic: a clinical staging system for adult osteomyelitis. Clinical Orthopaedics and Related Research (1976-2007). 2003;414:7-24.","DOI":"10.1097\/01.blo.0000088564.81746.62"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clinical Orthopaedics and Related Research (1976-2007). 2002;403:8-15.","DOI":"10.1097\/00003086-200210000-00003"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Hotchen AJ, Dudareva M, Ferguson JY, Sendi P, McNally MA. The BACH classification of long bone osteomyelitis. Bone & joint research. 2019;8(10):459-68.","DOI":"10.1302\/2046-3758.810.bjr-2019-0050.r1"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Metsemakers W-J, Kortram K, Morgenstern M, Moriarty T, Meex I, Kuehl R, et al. Definition of infection after fracture fixation: a systematic review of randomized controlled trials to evaluate current practice. Injury. 2018;49(3):497-504.","DOI":"10.1016\/j.injury.2017.02.010"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Rightmire E, Zurakowski D, Vrahas M. Acute infections after fracture repair: management with hardware in place. Clinical orthopaedics and related research. 2008;466:466-72.","DOI":"10.1007\/s11999-007-0053-y"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Naique S, Pearse M, Nanchahal J. Management of severe open tibial fractures: the need for combined orthopaedic and plastic surgical treatment in specialist centres. The Journal of bone and joint surgery British volume. 2006;88(3):351-7.","DOI":"10.1302\/0301-620x.88b3.17120"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Prada C, Bengoa F, Bhandari M. The management of fracture related infections: What practices can be supported by high-level evidence? Journal of Orthopaedic Surgery. 2022;30(3):10225536221119580.","DOI":"10.1177\/10225536221119580"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Berr\u00edos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA surgery. 2017;152(8):784-91.","DOI":"10.1001\/jamasurg.2017.0904"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Berkes M, Obremskey WT, Scannell B, Ellington JK, Hymes RA, Bosse M, et al. Maintenance of hardware after early postoperative infection following fracture internal fixation. JBJS. 2010;92(4):823-8.","DOI":"10.1007\/bf03089835"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Olszewski D, Streubel PN, Stucken C, Ricci WM, Hoffmann MF, Jones CB, et al. Fate of patients with a \u201csurprise\u201d positive culture after nonunion surgery. Journal of orthopaedic trauma. 2016;30(1):e19-e23.","DOI":"10.1097\/bot.0000000000000417"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Al-Mayahi M, Betz M, M\u00fcller DA, Stern R, Tahintzi P, Bernard L, et al. Remission rate of implant-related infections following revision surgery after fractures. International orthopaedics. 2013;37:2253-8.","DOI":"10.1007\/s00264-013-2092-1"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Kuehl R, Tschudin-Sutter S, Morgenstern M, Dangel M, Egli A, Nowakowski A, et al. Time-dependent differences in management and microbiology of orthopaedic internal fixation-associated infections: an observational prospective study with 229 patients. Clinical Microbiology and Infection. 2019;25(1):76-81.","DOI":"10.1016\/j.cmi.2018.03.040"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Hellebrekers P, Leenen LP, Hoekstra M, Hietbrink F. Effect of a standardized treatment regime for infection after osteosynthesis. Journal of Orthopaedic Surgery and Research. 2017;12(1):1-11.","DOI":"10.1186\/s13018-017-0535-x"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Haddad FS. Baron Larrey: A role model to be emulated. Journal of the American College of Surgeons. 2004;199(3):519.","DOI":"10.1016\/j.jamcollsurg.2004.05.266"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Guthrie H, Clasper J. Historical origins and current concepts of wound debridement. British Medical Journal Publishing Group; 2011. p. 130-2.","DOI":"10.1136\/jramc-157-02-01"},{"key":"ref35","unstructured":"Lowenberg D, Rupp M, Alt V, Browner B, Jupiter J, Krettek C, et al. Understanding and treating chronic osteomyelitis. Skeletal trauma: basic science, management, and reconstruction: Elsevier; 2019."},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Masters EA, Trombetta RP, de Mesy Bentley KL, Boyce BF, Gill AL, Gill SR, et al. Evolving concepts in bone infection: redefining \u201cbiofilm\u201d,\u201cacute vs. chronic osteomyelitis\u201d,\u201cthe immune proteome\u201d and \u201clocal antibiotic therapy\u201d. Bone research. 2019;7(1):20.","DOI":"10.1038\/s41413-019-0061-z"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Shaw JD, Brodke DS, Williams DL, Ashton NN. Methylene blue is an effective disclosing agent for identifying bacterial biofilms on orthopaedic implants. JBJS. 2020;102(20):1784-91.","DOI":"10.2106\/jbjs.20.00091"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Rupp M, Henssler L, Brochhausen C, Zustin J, Geis S, Pfeifer C, et al. Can necrotic bone be objectively identified in chronic fracture related infections?\u2014First clinical experience with an intraoperative fluorescence imaging technique. Injury. 2020;51(11):2541-5.","DOI":"10.1016\/j.injury.2020.07.062"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Draeger RW, Dahners LE. Traumatic wound debridement:a comparison of irrigation methods. Journal of orthopaedic trauma. 2006;20(2):83-8.","DOI":"10.1097\/01.bot.0000197700.19826.db"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Investigators F. A trial of wound irrigation in the initial management of open fracture wounds. New England Journal of Medicine. 2015;373(27):2629-41.","DOI":"10.1056\/nejmoa1508502"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Sendi P, McNally MA. Wound Irrigation in Initial Management of Open Fractures. New England journal of medicine NEJM. 2016;374(18):1788.","DOI":"10.1056\/NEJMc1601157"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Yusuf E, Jordan X, Clauss M, Borens O, M\u00e4der M, Trampuz A. High bacterial load in negative pressure wound therapy (NPWT) foams used in the treatment of chronic wounds. Wound repair and regeneration. 2013;21(5):677-81.","DOI":"10.1111\/wrr.12088"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Paley D, Lamm BM, Katsenis D, Bhave A, Herzenberg JE. Treatment of malunion and nonunion at the site of an ankle fusion with the Ilizarov apparatus. JBJS. 2006;88(1):119-34.","DOI":"10.2106\/jbjs.e.00862"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Foster AL, Moriarty TF, Zalavras C, Morgenstern M, Jaiprakash A, Crawford R, et al. The influence of biomechanical stability on bone healing and fracture-related infection: the legacy of Stephan Perren. Injury. 2021;52(1):43-52.","DOI":"10.1016\/j.injury.2020.06.044"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Obremskey W, Molina C, Collinge C, Nana A, Tornetta III P, Sagi C, et al. Current practice in the management of open fractures among orthopaedic trauma surgeons. Part A: initial management. A survey of orthopaedic trauma surgeons. Journal of orthopaedic trauma. 2014;28(8):e198-e202.","DOI":"10.1097\/bot.0000000000000033"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Casiraghi A, Galante C, Rohayem M, Vittone G, Domenicucci M, Cattaneo S, et al. Implant retention with serial debridement and use of antibiotic-loaded calcium sulfate beads in acutefracture-related infection (FRI) after pelvic ring or acetabular fractures: A retrospective case series of 7 cases. Injury. 2023;54(4):1082-7.","DOI":"10.1016\/j.injury.2023.01.045"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Morgenstern M, Kuehl R, Zalavras CG, McNally M, Zimmerli W, Burch MA, et al. The influence of duration of infection on outcome of debridement and implant retention in fracture- related infection: a systematic review and critical appraisal. The bone & joint journal. 2021;103(2):213-21.","DOI":"10.1302\/0301-620x.103b2.bjj-2020-1010.r1"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Buijs M, van den Kieboom J, Sliepen J, Wever K, van Breugel J, Hietbrink F, et al. Outcome and risk factors for recurrence of early onset fracture-related infections treated with debridement, antibiotics and implant retention: Results of a large retrospective multicentre cohort study. Injury. 2022;53(12):3930-7.","DOI":"10.1016\/j.injury.2022.10.017"}],"container-title":["Acta Orthopaedica Belgica"],"original-title":[],"deposited":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T11:01:29Z","timestamp":1737975689000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.actaorthopaedica.be\/archive\/volume-90\/issue-4\/original-studies\/can-we-dair-in-fri-debridement-techniques-in-osteomyelitis\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":49,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,1]]},"published-print":{"date-parts":[[2024,12]]}},"URL":"https:\/\/doi.org\/10.52628\/90.4.12423","relation":{},"ISSN":["0001-6462"],"issn-type":[{"value":"0001-6462","type":"print"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}