Bridging the Infected Defect: Modern Strategies for Canine Fracture‑Related Osteomyelitis
DOI:
https://doi.org/10.33687/ricosbiol.04.04.114Keywords:
Canine, osteomyelitis, fracture related infection, biofilm, local antibiotic delivery, bacteriophage therapy, Ilizarov technique, infected nonunionAbstract
Fracture‑related bone infection (osteomyelitis) remains a challenging complication in canine orthopaedic surgery. This review synthesizes current evidence on the management of fracture‑related infections (FRIs) in dogs, with emphasis on surgical debridement, implant management, systemic antibiotics, and emerging therapies. The standard of care achieves clinical success in many cases but is limited by biofilm formation. Local antibiotic delivery systems, such as resorbable calcium sulfate beads and antibiotic‑impregnated hydrogels, provide high local drug concentrations. Bacteriophage therapy has shown superior biofilm clearance and callus formation compared to conventional antibiotics in a preclinical canine model. Advanced surgical techniques—circular external skeletal fixation, bone transport osteogenesis, and orthogonal plating with autografts—offer solutions for infected nonunions. This review highlights a multimodal, evidence‑based approach and identifies priorities for future clinical research.
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Barbaro, K., Iacopetti, I., Perazzi, A., Contiero, B., & Zotti, A. (2024). Regenerative treatment of canine osteogenic lesions with Platelet-Rich Plasma and hydroxyapatite: A case report. Frontiers in Veterinary Science, 11 , 1459714. https://doi.org/10.3389/fvets.2024.1459714
Bird, F., Vallefuoco, R., & others. (2024). Pancarpal arthrodesis using antibiotic–impregnated calcium sulfate beads in a dog with septic arthritis and osteomyelitis. VCOT Open, 7 (01), e40–e45. https://doi.org/10.1055/s-0044-1785214
Cappellari, F., Piras, L., Panichi, E., Ferretti, A., & Peirone, B. (2014). Treatment of antebrachial and crural septic nonunion fractures in dogs using circular external skeletal fixation: A retrospective study. Veterinary and Comparative Orthopaedics and Traumatology, 27 (4), 297–305. https://doi.org/10.3415/VCOT-13-08-0102
Cho, H., Kang, B.-J., & Kim, J. (2026). Case report: Calcium sulfate antibiotic beads and bone morphogenetic protein-2–loaded hydroxyapatite and allograft for the treatment of infected delayed union in a dog. Frontiers in Veterinary Science, 13 , 1710429. https://doi.org/10.3389/fvets.2026.1710429
Ferreira, D. R. C., Montanhim, G. L., de Sá, M. A. R., Diogo, L. M. I., Minto, B. W., de Lucena, D. V. F., Moraes, P. C., & Dias, L. G. G. (2025). Septic nonunion in radius and ulna in a dog: Treatment with orthogonal plating associated with corticospongious bone autograft. Acta Scientiae Veterinariae. https://doi.org/10.22456/1679-9216.142367
Fitzpatrick, N., Driessen, B., & Schmierer, P. (2005). Clinical application of tobramycin-impregnated calcium sulfate beads in six dogs (2002–2004). Journal of the American Veterinary Medical Association. https://doi.org/10.1177/230949900201000110
González-Martín, M. R., Silva, V., Poeta, P., Corbera Sánchez, J. A., & Tejedor Junco, M. T. (2022). Microbiological aspects of osteomyelitis in veterinary medicine: Drawing parallels to the infection in human medicine. Veterinary Quarterly, 42 (1), 1–11. https://doi.org/10.1080/01652176.2021.2022244
Johnson, K. A. (2020). New strategies for bone infection management. Veterinary and Comparative Orthopaedics and Traumatology. https://doi.org/10.1055/s-0040-1714294
Jones, S., & Hudson, C. (2025). Clinical evaluations of a local antibiotic delivery device in six dogs. Veterinary and Comparative Orthopaedics and Traumatology, 38 (04), A1–A35. https://doi.org/10.1055/s-0045-1810346
Lee, S., Lee, H., & Kim, J. (2024). Surgical reconstruction of canine nonunion fractures using bone morphogenetic protein-2-loaded alginate microbeads and bone allografts. In Vivo, 38 (2), 611–619. https://doi.org/10.21873/invivo.13480
López-Barbeta, S., Vilar, J. M., Sopena, J. J., Damiá, E., Chicharro, D., Carrillo, J. M., Cuervo, B., & Rubio, M. (2019). Assessment of the efficacy of platelet-rich plasma in the treatment of traumatic canine fractures. International Journal of Molecular Sciences, 20 (5), 1075. https://doi.org/10.3390/ijms20051075
López-Píriz, R., Solá-Linares, E., Rodriguez-Portugal, M., Malpica, B., Díaz-Güemes, I., & others. (2015). Evaluation in a dog model of three antimicrobial glassy coatings: Prevention of bone loss around implants and microbial assessments. PLOS ONE, 10 (10), e0140374. https://doi.org/10.1371/journal.pone.0140374
Massie, A. M., Kapatkin, A. S., Fuller, M. C., Verstraete, F. J. M., & Arzi, B. (2017). Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2. Veterinary and Comparative Orthopaedics and Traumatology, 30 (2), 153–159. https://doi.org/10.3415/VCOT-16-05-0082
Ren, Y., Weeks, J., Xue, T., Rainbolt, J., Bentley, K. L. M., Shu, Y., Liu, Y., Masters, E., Cherian, P., McKenna, C. E., Neighbors, J., Ebetino, F. H., Schwarz, E. M., Sun, S., & Xie, C. (2023). Evidence of bisphosphonate-conjugated sitafloxacin eradication of established methicillin-resistant S. aureus infection with osseointegration in murine models of implant-associated osteomyelitis. Bone Research, 11 , 56. https://doi.org/10.1038/s41413-023-00287-4
Rigden, B. W., Stoker, A. M., Cook, C. R., Stannard, J. P., & Cook, J. L. (2024). Development and validation of a preclinical canine model for early onset fracture-related infections. Injury, 55 (12), 111957. https://doi.org/10.1016/j.injury.2024.111957
Schweser, K., Bozynski, C. C., Stoker, A. M., Gull, T., Duren, D., & Cook, J. L. (2025). Bacteriophage therapy for acute fracture-related infections: An effective treatment when compared with antibiotics in a canine model. Journal of Orthopaedic Trauma, 39 (3), 144–152. https://doi.org/10.1097/BOT.0000000000002950
Sedghizadeh, P. P., Sun, S., Junka, A. F., Richard, E., Seckinger, J., & others. (2017). Design, synthesis, and antimicrobial evaluation of a novel bone-targeting bisphosphonate-ciprofloxacin conjugate for the treatment of osteomyelitis biofilms. Journal of Medicinal Chemistry, 60 (6), 2326–2343. https://doi.org/10.1021/acs.jmedchem.6b01615
Smith, J. J., Chou, P.-Y., Filliquist, B., Marcellin-Little, D. J., & Kapatkin, A. S. (2023). Number of previous surgeries and antibiotic resistance decreases the success of local administration of antibiotic-impregnated poloxamer 407 hydrogel when managing orthopedic surgical site infections in dogs. Journal of the American Veterinary Medical Association. https://doi.org/10.2460/javma.23.02.0058
Ting, D., Petersen, S. W., & Déjardin, L. M. (2010). Bone transport osteogenesis for treatment of canine osteomyelitis: A report of two cases. Veterinary and Comparative Orthopaedics and Traumatology, 23 (2), 134–140. https://doi.org/10.3415/VCOT-09-04-0049
Yin, X., Fang, Z., Fang, Y., Zhu, L., Pang, J., Liu, T., Zhao, Z., & Zhao, J. (2022). Antimicrobial photodynamic therapy involving a novel photosensitizer combined with an antibiotic in the treatment of rabbit tibial osteomyelitis caused by drug-resistant bacteria. Frontiers in Microbiology, 13 , 876166. https://doi.org/10.3389/fmicb.2022.876166
Ziąbka, M., Matysiak, K., & Kaczmarek, Ł. (2020). Antibacterial composite hybrid coatings of veterinary medical implants. Materials Science and Engineering: C, 112 , 110968. https://doi.org/10.1016/j.msec.2020.110968
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Data Availability Statement
The data supporting the conclusions of this review are derived from previously published studies, which are cited throughout the manuscript. Any aggregated datasets used for comparative analysis, if applicable, are available from the corresponding author upon reasonable request.
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Copyright (c) 2026 Khaled A. Abd El-Razik, Abouelhag H. A.

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