Posts

Contemporary Concepts in Infection Prevention for Open Fractures: Focus on Antibiotic Prophylaxis and Surgical Protocols

/in /by

Vol 06 Issue 1 | January 2025 | page: 02-06 | Hatia Marandi, Aurobinda Das

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.62

Received 15/04/2024; Reviewed 23/05/2024; Accepted 08/10/2024; Published 10/01/2025

Authors: Hatia Marandi [1], Aurobinda Das [1]

[1] Department of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Aurobinda Das,
Department of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India.
Email: auro.d1984@gmail.com

Abstract

Introduction: Open fractures represent a critical orthopedic emergency characterized by significant soft-tissue disruption and a high propensity for infection, which can lead to devastating complications like chronic osteomyelitis and limb loss. Despite standardized care, infection rates remain high in severe injuries, necessitating a shift toward multimodal prevention strategies.
Objective: This review explores contemporary concepts in infection prevention for open fractures, specifically focusing on the evolution of systemic and local antibiotic delivery, innovations in implant technology, and evidence-based surgical protocols.
Methods: A synthesis of current clinical guidelines (WHO, CDC, and specialty societies) and recent research (up to 2025) was conducted to evaluate the efficacy of emerging prophylactic interventions and surgical site management techniques.
Results: Findings indicate that while prompt systemic antibiotic administration (within one hour of injury) remains the gold standard, adjunctive local delivery via antibiotic-impregnated beads or powders significantly reduces infection in high-grade fractures. Furthermore, innovations such as bioactive nanostructured implant coatings and pH-triggered antibacterial layers offer promising results in preventing biofilm formation. In surgical management, the selective use of prophylactic incisional negative pressure wound therapy (iNPWT) and standardized alcohol-based skin antisepsis have demonstrated efficacy in reducing surgical site infections (SSI).
Conclusion: Effective infection prevention in open fractures requires a transition from traditional monotherapy to a comprehensive, protocol-driven approach. Future directions emphasize the need for large-scale randomized trials to standardize local antibiotic dosing and the integration of “smart” biomaterials into routine clinical practice to further mitigate the burden of fracture-related infections.
Keywords: Open Fractures, Infection Prevention, Antibiotic Prophylaxis, Implant Coatings.

References

1. Laura Roberts, Mohamed Radwan Ahmed, Devendra K. Agrawal. Current Strategies in the Prevention and Management of Infection in Open Fractures. Journal of Orthopedics and Sports Medicine. 7 (2025): 218-229.
2. Schrank GM, Jozefowski N, Zura RD, Jeray KJ, Gary JL, Gaski GE, Shannon SF, Bzovsky S, Sprague S, Slobogean GP, Levack AE; PREP-IT Investigators*. Local Antibiotics and the Risk of Antimicrobial Resistance in Extremity Fractures Complicated by Fracture-Related Infection. J Bone Joint Surg Am. 2025 Jun 18;107(Suppl 1):28-35. doi: 10.2106/JBJS.24.01178. PMID: 40531179.
3. Chung HJ, Sohn HS. Fracture-related infections: a comprehensive review of diagnosis and prevention. J Musculoskelet Transl 2025; doi:10.46550/jmt.2025.00164. Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
4. Patel N, Gandhi B, Koriya D, Soni T. A Study Comparing Pre-Operative Prophylactic IV Antibiotics with Combined IV and Intraincisional Antibiotics Administration for Reducing Surgical Site Infections. European Journal of Cardiovascular Medicine. 2025;15(4):4264.
5. Busscher HJ, van Hengel IAJ, Elliott SJ, et al. Point-of-care antimicrobial coating protects orthopaedic implants from bacterial challenge. Nat Commun. 2021;12:5715. doi:10.1038/s41467-021-25383-z.
6. Zhang X, Xu S, Wei Y, Li S. Antibacterial coatings on orthopedic implants. Bioact Mater. 2023;29:130-147. doi:10.1016/j.bioactmat.2023.06.063.
7. Anwar M, Muhammed A, Anwar S. Fixing more than bones: The role of antibiotic stewardship in open fractures. Infectious Diseases Society of America Science Speaks Blog. 2025 Nov 10.
8. Accioni F, Vázquez J, Merinero M, Begines B, Alcudia A. Latest Trends in Surface Modification for Dental Implantology: Innovative Developments and Analytical Applications. Pharmaceutics. 2022 Feb 21;14(2):455. doi: 10.3390/pharmaceutics14020455. PMID: 35214186; PMCID: PMC8876580.
9. Kloster GA, Rivero G, Ballarre J, Herrera Seitz MK, Ceré SM, Abraham GA. Innovative pH-triggered antibacterial nanofibrous coatings for enhanced metallic implant properties. Frontiers in Materials. 2024;11:1484465. doi:10.3389/fmats.2024.1484465.
10. Ma X, Gao Y, Zhao D, Zhang W, Zhao W, Wu M, Cui Y, Li Q, Zhang Z, Ma C. Titanium Implants and Local Drug Delivery Systems Become Mutual Promoters in Orthopedic Clinics. Nanomaterials (Basel). 2021;12(1):47. doi:10.3390/nano12010047. PMCID: PMC8746425.
11. Talebian S, Mendes B, Conniot J, Farajikhah S, Dehghani F, Li Z, Bitoque D, Silva G, Naficy S, Conde J, Wallace GG. Biopolymeric coatings for local release of therapeutics from biomedical implants. Adv Sci (Weinh). 2023;10(12):2207603. doi:10.1002/advs.202207603.
12. Puga TB, Box MW, Haechten T, Qureshi I, Riehl JT. Effectiveness of surgical skin preparation solutions in orthopaedic surgery: A systematic review of the current comparative literature. World J Orthop. 2025 Oct 18;16(10):110741. doi: 10.5312/wjo.v16.i10.110741. PMID: 41181041; PMCID: PMC12576735.
13. Berríos-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 Surg. 2017;152(8):784-791.
14. Hemani ML, Lepor H. Skin preparation for the prevention of surgical site infection: which agent is best? Rev Urol. 2009 Fall;11(4):190-5. PMID: 20111631; PMCID: PMC2809986.
15. World Health Organization (WHO). Key facts on surgical site skin preparation [Internet]. Geneva: WHO; 2018 [cited 2025 Dec 1]. Available from: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/ssi/fact-sheet-skin-web.pdf
16. Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization; 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536404/
17. Leaper D, Rochon M, Pinkney T, Edmiston CE. Guidelines for the prevention of surgical site infection: an update from NICE. Infect Prev Pract. 2019 Nov 22;1(3-4):100026. doi: 10.1016/j.infpip.2019.100026. PMID: 34368683; PMCID: PMC8336317.
18. NICE. Surgical site infections: prevention and treatment (NG125). London (UK): National Institute for Health and Care Excellence; 2019 Apr 11 [updated 2020 Aug 19; reviewed 2023 May 31].
19. Zhang D, He L. A systemic review and a meta-analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings. Int Wound J. 2023 Jan;20(1):46-54. doi: 10.1111/iwj.13835. Epub 2022 May 10. Retraction in: Int Wound J. 2025 Apr;22(4):e70375. doi: 10.1111/iwj.70375. PMID: 35535660; PMCID: PMC9797922.
20. Groenen H, et al. Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. EClinicalMedicine. 2023;59:101981.
21. American College of Physicians. Clinical Practice Guidelines and Recommendations [Internet]. Philadelphia: ACP; [cited 2025 Dec 1]. Available from: https://www.acponline.org/clinical-information/clinical-guidelines-recommendations
22. American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guidelines [Internet]. Alexandria (VA): AAO-HNS; 2025 [cited 2025 Dec 1]. Available from: https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines
23. Zhai MZ, Dalal RS. Updated 2025 ACG clinical guideline for the management of Crohn’s disease. Evidence-Based GI. 2025 Sep 17. Available from: https://gi.org/journals-publications/ebgi/zhai_dalal_sep2025/

How to Cite this Article: Hatia Marandi H, Aurobinda Das A. Contemporary Concepts in Infection Prevention for Open Fractures: Focus on Antibiotic Prophylaxis and Surgical Protocol. The Odisha Journal of Orthopaedics and Trauma. January 2025; 06;01:02-06. https://doi.org/10.13107/ojot.2025.v06.i01.62

(Article Text HTML)      (Download Full Text PDF)

Negative pressure wound therapy… A healing touch approach to difficult wounds in orthopedic practice… A systematic review

/in /by

Vol 01 | January 2020 | page: 41-45 | Bikram Kar, Buddhadeb Nayak, Harshal Sakale, Alok C Agrawal

DOI- 10.13107/ojot.2020.v41i01.013

Authors: Bikram Kar [1], Buddhadeb Nayak [1], Harshal Sakale [1], Alok C Agrawal [1]

[1] Department of Orthopaedics, SCB Medical College, Cuttack, Odisha India.

Address of Correspondence
Dr. Buddhadeb Nayak,
SCB Medical College, Cuttack, Odisha India.
E-mail: buddhadeb9188@gmail.com

Abstract

The routine use of Negative Pressure Wound Therapy (NPWT) in big and complex wounds has gained the momentum over the past couple of years .In addition to surgical debridement for treating tissue defects around open fractures and chronic non healing ulcers, contaminated wounds in orthopaedic trauma, open fractures with soft tissue defects, its usage is frequently seen with increasing evidence to aid closed incisions having high risk of wound breakdown. Also the evidence for its use on skin grafts is now well established.
This review will analyze the available literature in order to summarize the current understanding of NPWT in terms of its mechanism of action, its applications, complications, contraindications and its future. Research on the application of NPWT in treating chronic non-healing wounds has largely taken the form of case studies, single-center studies, non-randomized controlled trials, with few randomized controlled trials (RCTs). Our aim is to summarize the current and emerging indications for negative pressure wound therapy in Orthopaedic trauma and the existing evidence for its use.
Keywords: Negative pressure wound therapy, Open fractures, Trauma, Wound management.

References

1. Huang C, Leavitt T, Bayer LR, Orgill DP. Effect of negative pressure wound therapy on wound healing. CurrProbl Surg. 2014;51:301-331.
2. Malmsjö M, Borgquist O. NPWT settings and dressing choices made easy. Wounds International. 2010;1:1-6.
3. Chariker ME, Jeter KF, Tintle TE, Ottsford JE. Effective management of incisional and cutaneous fistulae with closed suction wound drainage. Contemp Surg. 1989;34:59 63.
4. Campbell PE, Smith GS, Smith JM. Retrospective clinical evaluation of gauze-based negative pressure wound therapy. Int Wound J. 2008;5:280-286.
5. Malmsjo M, Ingemansson R, Martin R, Huddelston E. Negative pressure wound therapy using gauze or polyurethane open cell foam: similar early effects on pressure transduction and tissue contraction in an experimental porcine wound model. Wound Repair Regen. 2009;17(2):200–5.
6. Campbell PE, Smith GS, Smith JM. Retrospective clinical evaluation of gauze based negative pressure wound therapy. Int Wound J. 2008;5:280–6.
7. Kaufman M, Pahl D. Vacuum-assisted closure therapy: wound care and nursing implications. Dermatol Nurse. 2003;4:317–25.
8. Bickels J, Kollender Y, Wittig JC , et al. Vacuum-assisted closure after resection of musculoskeletal tumours. ClinOrthopRelat Res. 2005;441:346–50.
9. Shirikawa M, Isseroff R. Topical negative pressure devices. Arch Dermatol. 2005;141(11):144
10. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563-576; discussion 577
11. Kairinos N, Solomons M, Hudson DA. Negative-pressure wound therapy I: the paradox of negative-pressure wound therapy. PlastReconstr Surg. 2009;123:589-598; discussion 599-600.
12. Kairinos N, Solomons M, Hudson DA. The paradox of negative pressure wound therapy–in vitro studies. J PlastReconstrAesthet Surg. 2010;63:174-179.
13. Scherer SS, Pietramaggiori G, Mathews JC, Prsa MJ, Huang S, Orgill DP. The mechanism of action of the vacuum-assisted closure device. PlastReconstr Surg. 2008;122:786-797]
14. Borgquist O, Ingemansson R, Malmsjö M. The influence of low and high pressure levels during negative-pressure wound therapy on wound contraction and fluid evacuation. PlastReconstr Surg. 2011;127:551-559
15. Lancerotto L, Bayer LR, Orgill DP. Mechanisms of action of microdeformational wound therapy.Semin Cell Dev Biol. 2012;23:987-992. [PubMed] [DOI]
16. Younan G, Ogawa R, Ramirez M, Helm D, Dastouri P, Orgill DP. Analysis of nerve and neuropeptide patterns in vacuum-assisted closure-treated diabetic murine wounds. PlastReconstr Surg. 2010;126:87-96.
17. Armstrong DG, Lavery LA. Diabetic Foot Study Consortium.Negative pressure wound therapy after partial diabetic foot amputation: a multicntre randomized controlled trial. Lancet. 2005; 366(9498):1704
18. Rivilis I, Milkiewicz M, Boyd P, Goldstein J, Brown MD, Egginton S, Hansen FM, Hudlicka O, Haas TL. Differential involvement of MMP-2 and VEGF during muscle stretch- versus shear stress-induced angiogenesis. Am J Physiol Heart Circ Physiol. 2002;283:H1430-H1438.
19. Quinn TP, Schlueter M, Soifer SJ, Gutierrez JA. Cyclic mechanical stretch induces VEGF and FGF-2 expression in pulmonary vascular smooth muscle cells. Am J Physiol Lung Cell Mol Physiol. 2002; 282:L897-L903.
20. Urschel JD, Scott PG, Williams HT. The effect of mechanical stress on soft and hard tissue repair; a review. Br J Plast Surg. 1988;41:182-186.
21. Orgill DP, Manders EK, Sumpio BE, Lee RC, Attinger CE, Gurtner GC, Ehrlich HP. The mechanisms of action of vacuum assisted closure: more to learn. Surgery. 2009;146:40-51.
22. N. Kairinos, et al Wound Healing Southern Africa, Volume 10 Number 2, Dec 2017, p. 6 – 14.

How to Cite this Article: Kar B, Nayak B, Sakale H, Agrawal A C. | Negative pressure wound therapy… A healing touch approach to difficult wounds in orthopedic practice… a systematic review. | Odisha Journal of Orthopaedics and Trauma | January 2020; 01: 41-45 . https://doi.org/10.13107/ojot.2020.v41i01.013

(Abstract Text HTML)      (Download PDF)