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1Diagnosis

Infected fractures with or without bone loss

Definition

Open fractures can generally be regarded as contaminated. Since fractures in the dentate area have communication with the oral cavity, these are considered open fractures.
Infections with clinical relevance show swelling, pain, fever, reddening, and secretion of pus. In the case of acute infection radiographic signs can be absent. Chronic cases exhibit the typical signs of osteomyelitis.

Special conditions influencing adequate internal fixation
Instability produces and maintains the infectious process.

Osteosynthesis of an acutely infected fracture or pseudarthrosis must be a safe procedure. Under these conditions, high rigidity (load bearing) is mandatory. Therefore the locking reconstruction system 2.4 is recommended. It is important not to place any screws into the infected bone area which must be spared from screw insertion. The reconstruction plate functions as a bridging device. Large areas of infected or necrotic bone require debridemnet and either immediate or delayed cancellous bone grafting. Antibiotic therapy alone does not eliminate the infection as long as the fracture is unstable.

Clinical findings
Fractures in the dentate area are regarded as open fractures because the gingiva is usually lacerated. These fractures are contaminated. An acute infection is not reflected in the x-ray examination. In chronic cases the bone becomes infected exhibiting the typical clinical and radiographic signs of osteomyelitis.

In addition there will be inflammatory signs such as swelling, pain, fever, reddening, and secretion of pus.

Clinical photograph showing an infected fracture between the first and second molar. The pericoronal gingiva of the second molar contains pus and the swelling fills the vestibular sulcus.