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In Memory of Mark Shirtliff, PhD: Modern Concepts in Diagnosis, Treatment, Prevention, and Cost of Infection After Fracture Surgery

O’Toole, Robert V. MD; Harro, Janette PhD; Johnson, Aaron J. MD; O’Hara, Nathan N. MHA; Natoli, Roman M. MD, PhD; Joshi, Manjari MBBS

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Techniques in Orthopaedics: June 2020 - Volume 35 - Issue 2 - p 79-80
doi: 10.1097/BTO.0000000000000465
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This issue in Techniques in Orthopaedics is dedicated to our friend and colleague Mark Shirtliff, PhD. Dr Shirtliff had a remarkable career that was cut short tragically at the age of 49 during a rafting accident. Mark’s professional accomplishments were many (see details of his life and career at:, and he certainly will have a long-lasting effect on our field. His contributions included important discoveries and developments in the field of biofilm-mediated infection, as well as the selfless role he played as a mentor to so many other researchers. The sheer size and breadth of support for him shown at his memorial service speak to what an important influence he had on the many who had the pleasure of working with him.

Although Mark’s professional accomplishments were impressive, in many ways he was even more memorable for the type of person he was. He was one of the most charismatic, entertaining, and fascinating people that you could ever meet. Mark was the rare person who was able to give a basic science talk to clinicians that was simultaneously hilarious and thought-provoking. Most importantly he was a talented communicator who could convey complex information in a manner that even a clinician could understand. Any small meeting with Mark inevitably involved a lot of laughter and many outrageous comments—all part of the fun we had in working with him. His tremendous intelligence, creativity, and passion for science were wrapped up with his charm, lightning-quick wit, and self-deprecating modesty.

As Mark dedicated much of his professional life to a better understanding of biofilm-related infections, such as those observed after fracture surgery, we hope that this issue serves as an appropriate tribute to his career. Many of the authors of these articles worked closely with Dr Shirtliff for many years and his influence on our lives has been important to us.

The 6 articles in this symposium discuss many of the important issues pertaining to current approaches for prevention, diagnosis, and treatment of infections after orthopedic trauma surgery. Clinicians are well aware of the societal importance of the all too common deep infections after fracture surgery. Unfortunately, this is nowhere close to a solved problem,1 and much progress is needed. Dr Johnson and colleagues lead off the symposium with a detailed discussion of the problems that are endemic to timely and accurate diagnosis in the clinical management of patients with infection after fracture fixation. Dr Natoli and colleagues next lay out modern diagnostic techniques, such as those that were of particular interest to Dr Shirtliff, and their potential to help us with the problems the first article identified. The third article, led by Dr Wise, details the current evidence for risk factors associated with infection, followed by Dr Joshi who provides a comprehensive look at clinical measures that can be used for infection prevention. Dr Costales and colleagues detail the approach to treating infections after tibia fracture fixation, an issue that continues to plague fracture surgeons. The issue ends with Dr Levy and colleagues’ sophisticated look at the costs of infection after fracture-related surgeries. Taken together this body of work summarizes important issues and identifies areas for future work.

The authors are grateful of the journal for giving us the opportunity to present this information to the readers, and we hope that it serves as a small tribute to Mark Shirtliff.


1. Metsemakers WJ, Kuehl R, Moriarty TF, et al. Infection after fracture fixation: current surgical and microbiological concepts. Injury. 2018;49:511–522.
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