Managing infections in fractures treated with open reduction and internal fixation is an ongoing dilemma. Little published
data exist to support the current practice of treating these infections with retained hardware, irrigation, débridement, and
antibiotic suppression. We evaluated the effectiveness of this approach. We identified potential subjects from a central trauma
database and selected them based on chart review and specific inclusion and exclusion criteria. We divided the patients into
two groups. Patients achieving successful union with original hardware in place were considered as having successful results
and patients who required hardware removal before healing were considered to have failed results. Data, including age, gender,
tobacco use, diabetic status, site of fracture, Orthopaedic Trauma Association class, open grade, type of fixation, joint
involvement, and organism, were gathered and compared between the groups by analysis of variance. Sixty-nine cases were available
for analysis. Forty-seven (68%) were successful and 22 (32%) were unsuccessful. Average time to healing was 130 days. Most
of the failures occurred within 120 days from the time of injury. Smoking was a major risk factor with a 3.7 times greater
likelihood of procedures being unsuccessful per month than procedures among nonsmokers. Treating infected fractures with hardware
in place is less successful than widely believed.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent was obtained.