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Chronic Fracture-Related Infection

OVERVIEW

Chronic fracture-related infection (CFRI) is a complex and challenging condition that arises when a fracture, whether recent or from the past, becomes infected and persists over an extended period. This condition poses significant risks to the affected individual's overall health and can lead to severe complications if not properly managed. Dr Jason du Plessis specializes in the diagnosis and treatment of CFRI, employing both conservative and surgical approaches to ensure the best possible outcomes for his patients.

Types of chronic fracture-related infection:

CFRI can manifest in various forms, each presenting unique challenges for treatment. The primary types of CFRI include:

  1. Superficial infections: Infections limited to the skin and soft tissues around the fracture
  2. Deep infections: Infections that penetrate deeper into the bone, potentially leading to
  3. Biofilm-related infections: Bacterial biofilms, resilient colonies of microorganisms, can form on implants or fracture sites, complicating treatment.
  4. Late-onset infections: Infections that develop weeks or even months after the initial fracture, posing diagnostic challenges.

Causes of chronic fracture-related infection:

Several factors contribute to the development of CFRI:

  1. Initial trauma: The severity of the initial fracture and the trauma sustained can influence the risk of subsequent infection.
  2. Open fractures: Fractures that break the skin increase the risk of bacterial entry, leading to
  3. Implant-related factors: The presence of hardware such as screws or plates can contribute to infection, especially if not properly placed or if biofilm forms.
  4. Poor blood supply: Inadequate blood flow to the fractured area can impede the body's natural ability to fight off
SYMPTOMS
Recognizing the symptoms of CFRI is crucial for timely intervention. Common signs include:
  • Persistent pain: Pain that persists beyond the expected healing period for a fracture.
  • Swelling and redness: Inflammation and discolouration around the fracture site.
  • Fever and chills: Systemic signs of infection, indicating the body's response to the bacterial invasion.
  • Drainage or pus formation: Visible discharge from the fracture site, often indicative of an active infection.
TREATMENT
Conservative treatment

Dr Jason du Plessis emphasizes a comprehensive approach to CFRI, which may include:
  • Antibiotic therapy: Targeted antibiotics to combat the specific bacterial strain causing the infection.
  • Wound care: Thorough cleaning and management of the wound to prevent further infection.
  • Immobilization: Restricting movement of the affected limb to promote healing.
Surgical treatment

In cases where conservative measures prove insufficient, Dr du Plessis employs advanced surgical interventions, such as:
  • Debridement: Removal of infected tissue and debris to facilitate healing.
  • Implant removal or exchange: Addressing hardware-related infections by either removing or replacing implants.
  • Soft tissue reconstruction: Restoration of damaged soft tissues to optimize functional outcomes.
  • Bone grafting: Rebuilding bone defects caused by infection or surgical interventions.

FAQ

How is CFRI diagnosed?
Diagnosis includes a combination of clinical assessment, imaging studies, and laboratory tests to identify the presence of infection and determine its extent.
Can CFRI be treated with antibiotics alone?
In some cases, especially with early and superficial infections, antibiotics may be effective. However, advanced or deep infections often require surgical intervention for optimal outcomes.
How long does the treatment for CFRI typically take?
The duration of treatment varies based on the severity of the infection, the chosen treatment approach, and individual patient factors. Dr Jason du Plessis customizes treatment plans to ensure the best possible outcomes.

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    PUBLICATIONS

    Assessment of the Reliability and Reproducibility of the Langenskiöld
    Classification in Blount’s Disease

    DU PLESSIS J, Firth GB, Robertson A. Assessment of the reliability and reproducibility of the Langenskiöld classification in Blount's disease. Journal of Pediatric orthopedics. Part B. 2019 Nov 12.

     

    The Impact of the COVID-19 lockdown restrictions on orthopaedic trauma admissions in a central academic hospital in Johannesburg

    Foster M, Du Plessis J, Jansen van Vuuren M, Jingo M, Pietrzak JR. The impact of the COVID-19 lockdown restrictions on orthopaedic trauma admissions in a central academic hospital in Johannesburg. SA Orthopaedic Journal. 2022;21(2):70-5.

    Short term results following two stage revision for periprosthetic joint infection

    DU PLESSIS, J et al. Short-term results following two-stage revision for periprosthetic joint infection. South African Orthopaedic Journal, [S.l.], v. 19, n. 2, p. 64-69, may 2020

     

    Comparison of visual estimations of distal radius fracture radiographic parameters between different levels of orthopaedic doctors.

    Naidoo V, Milner B, du Plessis J. SA Orthop J. 2025;24(1):26-31. http://dx.doi.org/10.17159/2309-8309/2025/v24n1a4