summary Wound & Hardware Infection is the most common complication following orthopedic trauma surgery and is a significant source of patient morbidity. Diagnosis can be made clinically with the presence of incisional erythema, dehiscence, purulent drainage and/or persistent fracture nonunion or hardware loosening on radiographs Intraoperative deep cultures are the most reliable method to isolate causative organisms Treatment is usually surgical irrigation and debridement followed by culture-directed antibiotics. Hardware removal may be performed acutely or in a delayed fashion depending on fracture healing. Epidemiology Incidence up to 16% infection rate following traumatic fracture Risk factors host immunodeficiency extremes of age diabetes obesity alcohol or tobacco abuse steroid use malnutrition medications previous radiation vascular insufficiency Etiology Pathophysiology mechanisms login to view 6 more bullets Presentation History history of trauma must be detailed login to view 5 more bullets Symptoms pain at previous fracture site login to view 1 more bullet fevers, chills, and night sweats may be present Physical exam inspection login to view 2 more bullets motion login to view 1 more bullet Imaging Radiographs recommended views login to view 2 more bullets findings login to view 8 more bullets CT indications login to view 1 more bullet MRI indications login to view 2 more bullets sensitivity and specificity login to view 2 more bullets WBC-labeled scans can help determine infection from other similar appearing etiologies helpful to detect bony infection in the setting of hardware login to view 1 more bullet Studies Labs WBC login to view 1 more bullet erythrocyte sedimentation rate (ESR) login to view 1 more bullet C-reactive protein (CRP) login to view 3 more bullets Cultures in-office cultures swabs or aspirations of wounds or sinus tracts are unreliable intraoperative deep cultures are most reliable method of isolated causative organisms login to view 1 more bullet Treatment Nonoperative chronic suppression with antibiotics login to view 8 more bullets Operative surgical debridement login to view 10 more bullets