Infection complication after fracture has accompanied mankind from its very beginning and the different terminology for this complication has been used in the past, such as osteomyelitis, osteitis, etc. Only in the last decade, the denition of the specic term “fracture-related infection” (FRI) has put a more specic focus on this entity both on clinical and scientic aspects. This led to a clearer approach in diagnostics and decision-making and dedicated treatment algorithms. Recently, the development and introduction of the FRI­classication has achieved a better categorization of FRI patients, which is of importance due to the high variability in the clinical presentation from uncomplicated infections with healed fractures to complex situations with severe soft tissue defects or major bone defects.

and the reduction of revision procedures. Besides the important medical input of non-surgical expertise, e.g., from microbiology, infectious disease etc., the collaboration between orthopedic and orthopedic trauma surgeons on one side and plastic surgeons on the other side is of utmost importance for FRI patients as a high percentage of patients face both bone infection and soft tis­sue defects. Only the dedicated and targeted approach of both problems can lead to clinical success, for which the term “orthoplastic approach” was established in clinical practice and also in the scientic literature. This crucial improvement in the management of FRI patient is acknowledged by the cur­rent textbook as it does not only focus on the infected bone and implant but also on the soft tissue management and reliable wound coverage.

I congratulate the editor and all authors for this important book to advance treatment of FRI.I am deeply convinced that the readers will benet from the evidence and expert opinions that have been pulled together in this outstand­ing textbook.

It is often difcult for surgeons to condently answer questions regarding the optimal management of an individual FRI patient, even in the context of experienced multidisciplinary teams and after extensive literature searches. This is mainly because, on the one hand, the available literature is scarce, with much being yet unknown, and on the other hand, the great heterogeneity among publications considerably impairs data comparison between them. FRI itself is a very heterogeneous pathology, encompassing uncomplicated infections of healed fractures which resolve after implant removal, large infected bone defects and unsalvageable joints (which require much more complex treatments for FRI resolution), and everything in between, with vari­able host status and condition of the soft tissue envelope. Since no classica­tion system has yet been validated or uniformly accepted, different studies use different classications, making inter-study comparisons and data aggre­gation (something of particular importance, given the often small sample sizes) difcult. These difculties are coupled with the high variability of out­come measure reporting and overall low quality of the evidence (most study designs are retrospective and do not report on the authors’ rationale for the use of one treatment or another). The result is that the available clinical evi­dence to support decision-making is scarce, fragmented, and difcult to aggregate in a way that will inform clinical decision-making.