JAAOS - 2026-09-09 - Journal Article
Contemporary Update on Fracture-Related Infection: A Multidisciplinary Approach to Evaluation, Prevention, and Treatment.
Murphy TP, Weber EL, Robinson ED, Greenfield EM, Natoli RM
Topics
Key Takeaway
A consensus-based confirmatory/suggestive diagnostic framework for fracture-related infection (FRI) now standardizes evaluation, replacing ad hoc criteria, though specific numerical thresholds for serum and synovial markers remain incompletely validated.
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Summary
This narrative/systematic review synthesizes contemporary literature on FRI definition, prevention, diagnosis, and treatment from a multidisciplinary perspective. The consensus FRI definition stratifies findings into confirmatory (e.g., fistula, purulence, positive culture) and suggestive (e.g., elevated CRP, pain, radiographic changes) criteria to guide workup and management. Treatment principles center on eradicating or suppressing infection while achieving fracture consolidation, with antibiotic selection, surgical debridement strategy, and implant retention decisions individualized to host biology and fracture status.
Key Limitation
As a narrative review without quantitative synthesis, it cannot provide pooled effect sizes or evidence-based thresholds for diagnostic markers or treatment protocols, limiting its ability to resolve existing controversies in FRI management.
Original Abstract
Fracture-related infection (FRI) can be a devastating complication after fracture surgery and presents many challenges for the treating clinician. A consensus definition including clinical, radiographic, and laboratory components has standardized the diagnosis and investigative efforts into this complex problem. Orthopaedic surgeons managing fractures must be able to appropriately diagnose and treat FRI, while adhering to basic principles to eradicate or suppress infection and promote fracture consolidation. From a multidisciplinary perspective, this review article examines contemporary literature regarding the definition, prevention, patient evaluation, management, and societal effect of FRI.