# Managing Nonunions and Fracture-Related Infections—A Quarter Century of Knowledge, and Still Curious: A Narrative Review

## TL;DR

This review explores 25 years of progress in treating nonunions and fracture-related infections, emphasizing new diagnostic and therapeutic strategies.

## Contribution

The paper provides a narrative review of advancements in diagnostics and therapies for nonunions and fracture-related infections.

## Key findings

- Diagnostic methods have evolved from traditional cultures to molecular techniques like metagenomic sequencing.
- Therapeutic strategies now include orthoplastic management and antibiotic-loaded bone substitutes.
- Specialized centers are crucial for integrating these advancements into clinical practice.

## Abstract

Nonunions and fracture-related infections represent a significant complication in orthopedic and trauma care, with their incidence rising due to an aging, more comorbid global population and the escalating threat of multi-resistant pathogens. This narrative review highlights pivotal advancements in diagnostics and therapeutic approaches, while also providing an outlook on future directions. Diagnostic methodologies have significantly evolved from traditional cultures to sophisticated molecular techniques like metagenomic next-generation sequencing and advanced imaging. Simultaneously, therapeutic strategies have undergone substantial refinement, encompassing orthoplastic management for infected open fractures and the innovative application of antibiotic-loaded bone substitutes for local drug delivery. The effective integration of these possibilities into daily patient care critically depends on specialized centers. These institutions play an indispensable role in managing complex cases and fostering innovation. Despite considerable progress over the past 25 years, ongoing research, interdisciplinary collaboration, and a steadfast commitment to evidence-based practice remain crucial to transforming management for the future.