Definition and diagnosis of fracture-related infection

Martin McNally; Geertje Govaert; Maria Dudareva; Mario Morgenstern; Willem-Jan Metsemakers

doi:10.1302/2058-5241.5.190072

Definition and diagnosis of fracture-related infection

EFORT Open Rev. 2020 Oct 26;5(10):614-619. doi: 10.1302/2058-5241.5.190072. eCollection 2020 Oct.

Authors

Martin McNally¹, Geertje Govaert², Maria Dudareva¹, Mario Morgenstern³, Willem-Jan Metsemakers⁴

Affiliations

¹ The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
² Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands.
³ Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland.
⁴ Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.

Abstract

Fracture-related infection (FRI) is common and often diagnosed late.Accurate diagnosis is the beginning of effective treatment.Diagnosis can be difficult, particularly when there are no outward signs of infection.The new FRI definition, together with clear protocols for nuclear imaging, microbiological culture and histological analysis, should allow much better study design and a clearer understanding of infected fractures.In recent years, there has been a new focus on defining FRI and avoiding non-specific, poorly targeted treatment. Previous studies on FRI have often failed to define infection precisely and so are of limited value. This review highlights the essential principles of making the diagnosis and how clinical signs, serum tests, imaging, microbiology, molecular biology and histology all contribute to the diagnostic pathway. Cite this article: EFORT Open Rev 2020;5:614-619. DOI: 10.1302/2058-5241.5.190072.

Keywords: definition; diagnosis; fracture; fracture-related infection (FRI); histopathology; medical imaging; microbiology; serum inflammatory markers.

Publication types

Review