Update: This article was updated on July 2, 2020, because of previous errors. On page e44(4), in the legend for Figure 1, the sentence that had read “Diagnosis of fracture-related infection (FRI).” now reads “Diagnosis of fracture-related infection (FRI)²².” On page e44(5), the title for Table III that had read “Diagnostic Criteria for Fracture-Related Infection*¹⁴” now reads “Diagnostic Criteria for Fracture-Related Infection*²⁵.” An erratum has been published: J Bone Joint Surg Am. 2020 Aug 5;102(15):e93. Fracture-related infections (FRIs) are among the most common complications following fracture fixation, and they have a huge economic and functional impact on patients. Because consensus guidelines with respect to prevention, diagnosis, and treatment of this major complication are scarce, delegates from different countries gathered in Philadelphia in July 2018 as part of the Second International Consensus Meeting (ICM) on Musculoskeletal Infection. This paper summarizes the discussion and recommendations from that consensus meeting, using the Delphi technique, with a focus on FRIs. A standardized definition that was based on diagnostic criteria was endorsed, which will hopefully improve reporting and research on FRIs in the future. Furthermore, this paper provides a grade of evidence (strong, moderate, limited, or consensus) for strategies and practices that prevent and treat infection. The grade of evidence is based on the quality of evidence as utilized by the American Academy of Orthopaedic Surgeons. The guidelines presented herein focus not only on the appropriate use of antibiotics, but also on practices for the timing of fracture fixation, soft-tissue coverage, and bone defect and hardware management. We hope that this summary as well as the full document by the International Consensus Group are utilized by those who are charged with musculoskeletal care internationally to optimize their management strategies for the prevention and treatment of FRIs.

There has been an increase in the number of Level I and II trauma centers across the United States in the past few decades. However, data suggest that access to trauma care remains poor in rural areas of the country, while in many urban areas, trauma center density may be too high. Excessive trauma center proliferation in urban areas has the potential for negative effects on patient care and increased trauma system costs. The efficiency and competency of each trauma center may be decreased by having less access to patients, with research, surgeon experience, and training programs for residents, fellows, medical students, and other allied health providers all affected. Because of these concerns, the Orthopaedic Trauma Association (OTA) Health Policy Committee reviewed trauma center trends and trauma system needs and considered the potential effect of the increase in the number of centers on patient care as well as surgeon experience and training. This article reviews the different types of trauma centers and their designation process, as well as the growth in trauma centers during the past few decades. The committee identified and explored each of these issues and provides suggestions for improvement. Potential solutions identified include developing and applying strict criteria for determining the number of trauma centers needed within a given region, considering the needs of the local population, cost containment, and impact on adjacent trauma centers and their educational and research missions. There is opportunity for the OTA to work even more collaboratively with the American College of Surgeons to develop such criteria and to be involved with the orthopaedic accreditation and orthopaedic requirements. Collaboration between professional medical societies such as the OTA and American College of Surgeons and state and federal agencies is needed to help optimize the distribution of trauma centers.

Historically, intraoperative analysis of knee fracture procedures relied upon a fluoroscopic reduction assessment by the surgeon. This is a subjective assessment due to the lack of linear measurement reference data. Compared with the knee, the ankle and wrist have well-established bony anatomical relationships to guide reduction assessment during fracture treatment. The purpose of this study was to (1) determine the width ratios in the knee (plateau to femur) with aging, and (2) determine knee width changes with aging. One-hundred and fifty consecutive uninjured knee radiographs were reviewed. In all age groups, the width ratio of the articular distal femoral (ADF) to the articular tibial plateau (ATP) is greater than 1.0 and between 1.03 and 1.05. The tibia plateau width is on average 9.34 mm wider and the femoral width is 8.0 mm wider in the 61 to 80 age group than the ATP and the ADF in the younger age groups. In conclusion, the articular tibial plateau width and the articular distal femoral width are nearly equal across ages 20 to 80 years. An absolute articular width value by age cannot be assigned because articular widths change with aging.