Journal of Bone and Joint Infection最新文献

{"title":"Beyond the binary description of sinus tracts in periprosthetic joint infection.","authors":"Irene K Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Ricardo Sousa, Daniel Pérez-Prieto, Alex Soriano, Volker Alt, Willem J Metsemakers, Martin Clauss, Rihard Trebse","doi":"10.5194/jbji-11-651-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-651-2026","url":null,"abstract":"<p><p>Current periprosthetic joint infection (PJI) definitions classify sinus tracts as present or absent. While this binary approach is appropriate for diagnosing PJI, it does not capture the heterogeneity of sinus tracts relevant to surgical decision-making. We propose that future studies explore a standardized characterization of sinus tract complexity to better inform surgical treatment.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"651-654"},"PeriodicalIF":2.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The co-occurrence of peri-prosthetic fracture and infection: a scoping review on current diagnostic principles, treatment and outcome.","authors":"Noémie Reinert, Laura Bessems, Martin Clauss, Nader Maai, Jolien Onsea, Georges Vles, Karl Stoffel, Willem-Jan Metsemakers, Mario Morgenstern","doi":"10.5194/jbji-11-635-2026","DOIUrl":"10.5194/jbji-11-635-2026","url":null,"abstract":"<p><p><b>Background</b>: The co-occurrence of periprosthetic fractures and infection, referred to as infected periprosthetic fracture (iPPF), represents a highly burdensome complication in orthopedic surgery. Management is challenging since not rarely treatment principles of prosthetic joint infections and fracture-related infections have to be combined. The aim of this scoping review was to map the current literature on management and outcome of iPPFs. <b>Methods</b>: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Five major databases were systematically searched. Studies reporting on diagnostic principles and/or treatment strategies for iPPF around the hip and knee were included. Data were mapped regarding study design, diagnostic approaches, surgical strategies, and outcome. <b>Results</b>: A total of 32 studies comprising 273 patients with iPPFs were included; 8 addressed diagnostic strategies, and 24 reported on treatment and outcome. Diagnostic studies demonstrated limited reliability of serum inflammatory markers, and although synovial fluid analysis appeared most informative, optimal thresholds remain uncertain. Most treatment studies were small and heterogeneous. A staged surgical approach, predominantly two-stage revision, was reported in 83 % of the included studies. Across nine studies reporting outcomes, mean infection eradication and recurrence rates were 76.1 % and 22.3 %, respectively. The majority of the studies (58.3 %) described that additional surgeries were needed to cure infection. Fracture healing outcomes were inconsistently reported (bone healing in 4 out of 9 studies with 53/58 fractures, mean 91.4 %). <b>Conclusion</b>: This scoping review demonstrates that management of iPPFs remains highly challenging, with high rates of recurrent infection and unplanned revision surgery. However, the reported quantitative outcome data represent descriptive summaries derived from heterogeneous, predominantly small observational studies and case series and should not be interpreted as definitive benchmarks for clinical outcomes. The current evidence base remains limited, highlighting the need for standardized diagnostic criteria, uniform outcome reporting, and well-designed prospective multicenter studies.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"635-649"},"PeriodicalIF":2.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning in diabetic-foot osteomyelitis: current applications, challenges, and future directions.","authors":"Farzad Pourghazi, Seyed Mohammad Amin Alavi, Francesco Petri, Takahiro Matsuo, Sergio Alvarez Mulett, Fabio Borgonovo, Andrea Gori, Michael E Torchia, Aaron J Tande, Elie F Berbari","doi":"10.5194/jbji-11-623-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-623-2026","url":null,"abstract":"<p><p><b>Background</b>: Diabetic-foot osteomyelitis (DFO) is a severe complication of diabetic-foot ulcers associated with delayed healing, amputation, and increased mortality. Machine learning (ML) has increasingly been explored for diagnosis and clinical decision-making in diabetic-foot care; however, the current evidence specific to DFO has not been systematically synthesized. <b>Methods</b>: We performed systematic searches of MEDLINE, Embase, Scopus, and Web of Science for studies published between January 2000 and May 2026. Studies that developed or evaluated ML models for DFO diagnosis, prediction, or outcomes were included. Data extraction was performed using the CHARMS framework, reporting followed PRISMA 2020 and TRIPOD-SRMA recommendations, and methodological quality was evaluated using PROBAST <math><mo>+</mo></math> AI. Due to considerable heterogeneity, narrative synthesis was performed. <b>Results</b>: A total of 10 studies published from 2022 to 2026 met the inclusion criteria. Five studies developed or evaluated ML models with a direct DFO diagnostic endpoint, one additional study evaluated model explainability, and four evaluated complementary DFO-relevant diabetic-foot applications. Reported discrimination ranged from 0.879 to 0.998, but comparisons were limited by differences in clinical endpoints, reference standards, input modalities and validation strategies. Only one direct DFO model was externally validated, and no study developed a multimodal model combining clinical and imaging data. <b>Conclusion</b>: Current evidence is limited by heterogeneous methodologies, limited external validation, and inconsistent reporting despite promising discrimination reported by several models. Future studies should evaluate whether multimodal models integrating clinical and imaging data provide incremental value over unimodal approaches, with external validation, calibration, and clinical utility assessment before clinical implementation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"623-634"},"PeriodicalIF":2.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High preoperative CONUT score is associated with treatment failure and mortality after surgery for acute periprosthetic joint infection: a single-centre retrospective cohort study.","authors":"Víctor Otero-Naveiro, Blanca Ayuso-García, Silvia Pena-Paz, Ricardo Andrés Rión-Giraldo, María José García-Pais, Alejandro López-Pardo Pardo","doi":"10.5194/jbji-11-613-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-613-2026","url":null,"abstract":"<p><p><b>Introduction:</b> Acute periprosthetic joint infection (PJI) is associated with substantial morbidity and mortality. The controlling nutritional status (CONUT) score combines serum albumin, total lymphocyte count, and total cholesterol, and may reflect host vulnerability. This study evaluated whether preoperative CONUT is associated with failure and mortality after surgery for acute PJI. <b>Methods:</b> We performed a single-centre retrospective cohort study of patients surgically treated for acute postoperative or acute haematogenous hip or knee PJI between 1 January 2013 and 30 November 2024. PJI was defined according to EBJIS criteria. CONUT was calculated from preoperative blood tests and dichotomised as low ( <math><mo><</mo></math> 5; normal to mild) or high ( <math><mo>≥</mo></math> 5; moderate to severe). Outcomes were defined using an adapted MSIS-ORT classification as failure, total failure including death within 1 year, and overall mortality. <b>Results:</b> Of 169 screened patients, 59 were excluded for missing CONUT data and 90 were included; <math><mrow><mn>42</mn> <mo>/</mo> <mn>90</mn></mrow> </math> (46.7 %) had high CONUT. High CONUT was associated with higher failure (35.7 % vs. 10.4 %; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.004</mn></mrow> </math> ), total failure (57.1 % vs. 12.5 %; <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ), and overall mortality (61.9 % vs. 22.9 %; <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). Adjusted analyses confirmed independent associations with failure (odds ratio (OR) 4.24, 95 % confidence interval (CI) 1.34-13.46; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.014</mn></mrow> </math> ), total failure (OR 9.57, 95 % CI 2.91-31.50; <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ), and overall mortality (hazard ratio (HR) 2.73, 95 % CI 1.29-5.74; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.008</mn></mrow> </math> ). <b>Conclusions:</b> High preoperative CONUT was associated with failure, total failure, and overall mortality after surgery for acute PJI. It may support risk stratification but should not be viewed solely as a nutritional marker, as its components may reflect systemic inflammation, bacteraemia, and infection severity.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"613-622"},"PeriodicalIF":2.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for treatment failure of surgical site deep infections following spinal instrumentation: multicentre observational study (DeFEndO study).","authors":"Renato Pascale, Mena Gallo, Nicolò Regge Gianas, Giacomo Fornaro, Irene Grassi, Manuel Zagarrigo, Andrea Grechi, Alberto Zuppiroli, Dario Santoro, Elena Tenti, Luca Boriani, Eleonora Zamparini, Alessandro Gasbarrini, Pierluigi Viale, Maddalena Giannella, Stefania Curti, Sara Tedeschi","doi":"10.5194/jbji-11-601-2026","DOIUrl":"10.5194/jbji-11-601-2026","url":null,"abstract":"<p><p><b>Introduction</b>: To describe the characteristics and outcome of patients diagnosed with deep surgical-site infections following spinal instrumentation (DSIIs) and to investigate risk factors for treatment failure including antimicrobial treatment duration as the main exposure. <b>Materials and methods</b>: An observational retrospective study on patients diagnosed with DSII from January 2018 to June 2022 in two large hospitals. Two multivariable analyses were carried out to evaluate risk factors for treatment failure considering two treatment schedules: 8-week versus 12-week. <b>Results</b>: We enrolled 161 patients, median age 62 years (IQR: 51-69), 55.1 % male, median Charlson comorbidity index of 3 (IQR: 1-4). Gram-positive and Gram-negative bacteria were responsible for DSII in 60.3 % and 33.8 % of cases. Polymicrobial infections accounted for 42 cases (26.4 %). Treatment failure was observed in 51 (31.7 %) patients. Multivariable analyses were conducted to evaluate risk factors for treatment failure using treatment duration cutoffs of 8 weeks and 12 weeks. Quinolone administration was associated with a lower risk of treatment failure in both treatment schedules (8 weeks: OR 0.11, 95 % CI 0.02-0.71, <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.020</mn></mrow> </math> ; 12 weeks: OR 0.11, 95 % CI 0.02-0.64, <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.015</mn></mrow> </math> ). Gram-negative aetiology of DSII was a risk factor for treatment failure (8 weeks: OR 4.20, 95 % CI 1.08-16.38, <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.039</mn></mrow> </math> ; 12 weeks: OR 4.46, 95 % CI 1.15-17.23, <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.030</mn></mrow> </math> ). <b>Conclusions</b>: DSII caused by Gram-negative bacteria was associated with a higher risk of worse outcomes. Quinolone use appeared to be associated with a lower risk of treatment failure, but this finding should be interpreted with caution given the potential for residual confounding. No significant association between treatment duration and outcome was observed in our exploratory analyses.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"601-611"},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of the KLIC score and development of a novel prediction model for debridement, antibiotics, and implant retention failure in prosthetic joint infection: a multicentre cohort study.","authors":"Giulia Zumbo, Iris Martínez-Alemany, Jose Maria Bravo-Ferrer, Isabel Nieto Diaz De Los Bernardos, Julia Praena, Alfonso Del Arco, Enrique Nuño, Juan Enrique Corzo Delgado, Francisco Brun, Clara Natera, Alberto Romero Palacios, Beatriz Sobrino, Jesús Rodríguez-Baño, María-Dolores Del-Toro-López","doi":"10.5194/jbji-11-591-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-591-2026","url":null,"abstract":"<p><p>Appropriate estimation of the risk of failure after debridement, antibiotics, and implant retention (DAIR) may provide useful prognostic information in patients with prosthetic joint infection (PJI). We aimed to externally validate the Kidney, Liver, Index surgery, Cemented prosthesis, C-reactive protein (KLIC) score and to develop and internally validate a new prediction model based on variables available before DAIR. We conducted a retrospective multicentre cohort study using medical record data from adults with PJI treated with DAIR across eight Spanish centres between 2006 and 2023, with a minimum 12-month follow-up. Predictors were analysed using a generalized linear mixed-effects model, with assessment of discrimination, calibration, and bootstrap internal validation. Among 224 patients, 121 (54 %) experienced DAIR failure. The final model retained revision prosthesis, Charlson Comorbidity Index <math><mo>≥</mo></math> 3, C-reactive protein <math><mo>></mo></math> 150 mg L^-1, longer time from index arthroplasty to DAIR, and Gram-negative bacilli or polymicrobial infection. The model showed good discrimination (Areas under the receiver operating characteristic curve (AUC-ROC) 0.85; 95 % confidence interval (CI) 0.79-0.90) and satisfactory calibration; the optimism-corrected AUC-ROC was 0.83. The derived clinical score showed an AUC-ROC of 0.81 (95 % CI 0.75-0.87) and identified groups with observed failure rates of 25.5 %, 45.6 %, and 87.9 %. The KLIC score did not demonstrate discriminative ability beyond chance (AUC-ROC 0.53; 95 % CI 0.44-0.64). Excluding microbiological aetiology reduced discrimination to 0.81 for the multivariable model and 0.77 for the corresponding reduced score. The new model showed good discrimination and calibration in this cohort, but external validation in independent PJI-DAIR populations is required before clinical implementation can be recommended.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"591-599"},"PeriodicalIF":2.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of vascularized fibular grafting for infected non-union of the lower limb: a competing-risk analysis.","authors":"Anne Le Hir, Piseth Seng, David Delarbre, Romain Ambrosino, Najib Kachouh, Régis Legré, Andreas Stein","doi":"10.5194/jbji-11-579-2026","DOIUrl":"10.5194/jbji-11-579-2026","url":null,"abstract":"<p><p><b>Background</b>: Infected non-union of the lower limb is among the most challenging conditions in orthopedic surgery. Vascularized fibular grafting (VFG) is a limb-salvage option for large infected bone defects, but outcomes accounting for competing events remain poorly documented. <b>Methods</b>: We conducted a retrospective single-center study of adults treated consecutively with VFG for infected femoral or tibial non-union between 2014 and 2023. Infected non-union combined institutional non-union criteria with fracture-related infection as per international consensus definitions. Treatment success was defined as consolidation with infection remission. Amputation and death were competing events; cumulative incidence of consolidation was estimated using competing-risk methods. <b>Results</b>: A total of 22 patients were included (median age of 45 years). Consolidation was achieved in 17 patients (77 %), infection remission was achieved in 16 (73 %), and treatment success was achieved in 16 (73 %): 9 (41 %) after VFG alone and 7 (32 %) after secondary bone grafting. Six patients (27 %) had unfavorable outcomes: four amputations, one persistent non-union, and one death. The median time to consolidation was 14 months after VFG alone and 38 months after secondary grafting. Cumulative incidence of consolidation reached approximately 18 % at 12 months, 41 % at 24 months, 59 % at 36 months, and 76 % by end of follow-up. All seven patients undergoing secondary grafting for delayed consolidation ultimately achieved union; no formal comparative analysis was performed given the small, time-dependent sample. <b>Conclusion</b>: VFG is a valuable limb-salvage strategy for selected patients with infected non-union. Consolidation may occur late, underscoring the need for prolonged follow-up and competing-risk methodology. Findings should be interpreted given the retrospective design, small sample, and heterogeneous follow-up.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"579-590"},"PeriodicalIF":2.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating long-term quality of life and depressive symptoms following fracture-related infection: a systematic review with meta-analysis of heterogeneous evidence.","authors":"Johann Alexander Betker, Nike Walter, Markus Rupp, Susanne Baertl, Volker Alt","doi":"10.5194/jbji-11-569-2026","DOIUrl":"10.5194/jbji-11-569-2026","url":null,"abstract":"<p><p><b>Background</b>: Fracture-related infection (FRI) is associated with prolonged treatment courses and functional impairment. However, the long-term effects of FRI on quality of life (QoL) and psychological outcomes remain unclear. <b>Methods</b>: A PRISMA-compliant systematic review of PubMed, Web of Science, and Google Scholar for studies published from 2010 to August 2025 was performed. Methodological quality and bias were assessed with Methodological Index for Non-Randomised Studies (MINORS) and ROBINS-I. Where appropriate, data were synthesized using random-effects models and interpreted cautiously due to substantial heterogeneity. <b>Results</b>: Fifteen studies met the inclusion criteria. The evidence base is dominated by retrospective cohorts: mean MINORS attainment 66.4 % and mean loss to follow-up 19.5 %. Meta-analysis of three studies ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>125</mn></mrow> </math> ) showed non-significant mean changes at 12 months or more in SF-36 and SF-12 physical component score (PCS) of 5.81 (SD 6.54, <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.124</mn></mrow> </math> ) and 3.86, (9.12, <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.463</mn></mrow> </math> ) in the mental component (MCS). Pooled long-term estimates from seven studies ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>262</mn></mrow> </math> ) were 38.9 (2.18) for PCS and 51.2 (4.11) for MCS. Compared with US population norms, PCS was reduced, whereas differences in mental QoL were not significant. Three studies ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>118</mn></mrow> </math> ) assessing psychological symptoms using the ISR reported elevated depressive symptom and total ISR scores exceeding established caseness thresholds. <b>Discussion</b>: Current evidence suggests persistent physical and psychological burden after FRI treatment. However, heterogeneity, limited study quality, evolving FRI definitions, and a lack of appropriate comparison groups prevent definitive conclusions. Prospective studies using standardized outcome measures are required.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"569-577"},"PeriodicalIF":2.7,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical case of polymicrobial and multidrug-resistant posttraumatic chronic hip infection treatment.","authors":"Urban Vadnjal, Samo Roškar, René Mihalič, Mitja Rak, Rihard Trebše","doi":"10.5194/jbji-11-565-2026","DOIUrl":"10.5194/jbji-11-565-2026","url":null,"abstract":"<p><p>A 40-year-old man, after a left acetabular fracture, had eight surgeries, suffered from chronic multidrug-resistant infection with fistula, and underwent multi-stage hip revision surgery with spacer exchange and reconstruction, combined with systemic and intra-articular antibiotic therapy. He remained infection-free at 3.5-year follow-up.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 5","pages":"565-568"},"PeriodicalIF":2.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonication versus peri-implant tissue culture in fracture-related infection: diagnostic performance and therapeutic consequences in a single-center cohort.","authors":"Belal Abdo, Daniel Strack, Marcel Schäuffele, Tim Ludwig Tüngler, Can Imirzalioglu, Anita Windhorst, Moritz Fritzenwanker, Christian Heiss, Markus Rupp","doi":"10.5194/jbji-11-555-2026","DOIUrl":"10.5194/jbji-11-555-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Fracture-related infections (FRIs) represent a severe complication and pose diagnostic challenges due to biofilm-associated microorganisms. While peri-implant tissue culture (PTC) remains the standard, its sensitivity is limited. Sonication of explanted osteosynthesis material has been proposed as a complementary diagnostic tool; however, its contribution remains controversial. The aim of this study was to compare sonication and peri-implant tissue culture and their impact on antimicrobial management. <b>Methods</b>: In this retrospective single-center study, all patients undergoing implant removal for FRI between 2016 and 2023 were screened. Cases with peri-implant tissue cultures and sonication fluid cultures (SFCs) were included. The diagnostic yield and pathogen spectrum of PTC and SFC were compared, including analyses in patients receiving antibiotic therapy. The impact of microbiological findings on antibiotic management was evaluated. <b>Results</b>: Of 287 screened cases, 157 patients met the inclusion criteria. Pathogen detection was achieved in 60.5 % using PTC and 57.3 % using SFC. Incorporating both methods increased the diagnostic yield to 70.1 %. Sonication identified additional pathogens in 17.8 % of cases and PTC in 22.9 %. Under antibiotic therapy, PTC demonstrated a slightly higher diagnostic yield than SFC. Antibiotic therapy was modified after revision surgery in 47.8 % of cases, while sonication alone influenced treatment decisions in 4.5 % of patients. <b>Conclusions</b>: Neither PTC nor SFC alone achieved the diagnostic performance of their combined use. Combined testing improved diagnostic yield, supported targeted antimicrobial management, and reinforced the value of a multimodal microbiological approach to FRI.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"555-563"},"PeriodicalIF":2.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}