Lewandowski LR, et al. - In this retrospective observational case-control study, the investigators researched the factors responsible for osteomyelitis development in US military personnel with combat-related, open femur fractures among 103 subjects. They observed that osteomyelitis cases (among subjects with surgical implants) had significantly longer time to definitive orthopedic surgery as compared to controls with median 21 vs 13 days, respectively. They recorded Gustilo–Anderson classification (transfemoral amputation OR: 19.3; CI: 3.0–123.0) and Orthopaedic Trauma Association Open Fracture Classification for muscle loss and dead muscle, the independent predictors for osteomyelitis risk. They reported foreign body contamination as the only significant factor when an implant was present. They suggested an increased risk with antibiotic bead use as a substitute for clinical doubt of contamination with complex wounds.