SymposiumHow to Diagnose Surgical Site Infection After Fracture Surgery: We Have a Problem!Johnson, Aaron J. MD; O’Toole, Robert V. MDAuthor Information Department of Orthopaedics, University of Maryland School of Medicine, University of Maryland, Baltimore, MD The authors declare that they have nothing to disclose. For reprint requests, or additional information and guidance on the techniques described in the article, please contact Robert V. O’Toole, MD, at firstname.lastname@example.org or by mail at Department of Orthopaedics, University of Maryland School of Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques. Techniques in Orthopaedics: June 2020 - Volume 35 - Issue 2 - p 81-90 doi: 10.1097/BTO.0000000000000462 Buy Metrics Abstract Infections after fracture are often devastating complications and despite widespread efforts to these infections, there are still 100,000 cases of reported fracture-related infection yearly in the United States. Although infection after fracture surgery is common, there is important uncertainty regarding various aspects of diagnosing these infections including a lack of standardization of what the definition of an infection should be in this setting. Most infections after fracture surgery present with obvious clinical signs of infection, but sometimes the signs are more subtle. Furthermore, it is not possible to obtain diagnostic tissue samples before taking the patient to the operating room for debridement thus potentially making it difficult to know what the best surgical strategy should be. When treating infections, clinicians attempt to determine definitively whether the patient is infected, how much surgical debridement is necessary, what pathogen they need to treat, and how many surgical debridements are needed. Diagnostic uncertainty affects all of these aspects of care and can cause unnecessary surgery, delayed surgical debridement, inadequate site control, and difficulty determining when the patient has cleared their infection. The purpose of this manuscript will be to evaluate the current diagnostic tests available to answer each of the above questions, and the available evidence supporting their use. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.