Aims. This study aimed to investigate the clinical characteristics and outcomes associated with culture-negative limb osteomyelitis patients. Methods. A total of 1,047 limb osteomyelitis patients aged 18 years or older who underwent debridement and intraoperative culture at our clinic centre from 1 January 2011 to 31 December 2020 were included. Patient characteristics, infection eradication, and complications were analyzed between culture-negative and culture-positive cohorts. Results. Of these patients, 264 (25.2%) had negative cultures. Patients with a culture-negative compared with a culture-positive status were more likely to have the following characteristics: younger age (≤ 40 years) (113/264 (42.8%) vs 257/783 (32.8%); p = 0.004), a haematogenous aetiology (75/264 (28.4%) vs 150/783 (19.2%); p = 0.002), Cierny-Mader host A (79/264 (29.9%) vs 142/783 (18.1%); p < 0.001), antibiotic use before sampling (34/264 (12.9%) vs 41/783 (5.2%); p＜0.001), fewer taken samples (n＜3) (48/264 (18.2%) vs 60/783 (7.7%); p＜0.001), and less frequent presentation with a sinus (156/264 (59.1%) vs 665/783 (84.9%); p < 0.001). After initial treatments of first-debridement and antimicrobial, infection eradication was inferior in culture-positive osteomyelitis patients, with a 2.24-fold increase (odds ratio 2.24 (95% confidence interval 1.42 to 3.52)) in the redebridement rate following multivariate analysis. No statistically significant differences were found in long-term recurrence and complications within the two-year follow-up. Conclusion. We identified several factors being associated with the culture-negative result in osteomyelitis patients. In addition, the data also indicate that culture negativity is a positive prognostic factor in early infection eradication. These results constitute the basis of optimizing clinical management and patient consultations. Cite this article: Bone Joint J 2024;106-B(7):720–727

Objectives. The risk of infection after type III° open fractures is high (10–50%). Preemptive antibiotic therapy may prevent posttraumatic infection and improve the outcome. Recommendations about the type and duration of antibiotic vary among the institutions and it remains unclear whether gram-negative bacilli or anaerobs need to be covered. In Europe, the most commonly recommended antibiotic is amoxicillin/clavulanic acid. We retrospectively analyzed microbiology, characteristics and outcome of patients with open type III° fractures treated at our institution. Methods. Between 01/2005 and 12/2009 we retrospectively included all type III grade open fractures of the leg at our institution classified after Gustilo (JBJS Am 1976) into type IIIA (adequate soft-tissue coverage of bone with extensive soft-tissue laceration or flaps), IIIB (extensive soft-tissue loss with periosteal stripping and bone exposure), and IIIC (requiring arterial injury repair). Demographic characteristics, clinical presentation, microbiology, surgical and antibiotic treatment and patient outcome were recorded using a standardized case-report form. Results. 30 cases of patients with type III° open fractures were included (25 males, mean age was 40.5 years, range 17–67 years). 27 fractures (90%) were located on the lower leg and 3 (10%) on the upper leg. 24 cases (80%) were high-energy and almost half of the patients (n=16, 53%) had a polytrauma. Microbiology at initial surgery was available for 19 cases (63%), of which 10 grew at least one organism (including 8 amoxicillin/clavulanic acid-resistant gram-negative bacilli [GNB], 7 amoxicillin/clavulanic acid-resistant Bacillus cereus), 11 were culture-negative. Preemptive antibiotics were given in all cases (100%) for an average duration of 8.5 days (range 1–53 days), the most common antibiotic was amoxicillin/clavulanic acid in 60 % (n=18). 11 cases just received preemptive antibiotic treatment, in 19 of 30 cases the antibiotic therapy was changed and prolonged. Microbiology at revision surgery was available for 25 cases and 22 grew at least one pathogen (including 32 amoxicillin/clavulanic acid-resistant gram-negative bacilli and 10 amoxicillin/clavulanic acid-resistant Bacillus cereus), 3 were culture-negative. Conclusions. At initial surgery, most common isolated organisms were coagulase-negative staphylococci (43%), Bacillus cereus (23%), and gram-negative bacilli (27%), and others (7%) of which 48% were resistant to amoxicillin/clavulanic acid. At revision surgery, isolated organisms were gram-negative bacilli (64%), Bacillus cereus (20%), and others (16%) of which 88% were resistant to amoxicillin/clavulanic acid. The spectrum of amoxicillin/clavulanic does not cover the most common isolated organisms

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The aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related infection (FRI).

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Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture.

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Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort.