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Definition and diagnosis of fracture-related infection
Martin McNally1, Geertje Govaert2, Maria Dudareva1
1The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
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.
Insights
Accurate diagnosis of fracture-related infection (FRI) is crucial for effective treatment. New definitions and protocols improve the study and understanding of infected fractures.
Area of Science:
- Orthopedics
- Infectious Diseases
- Diagnostic Imaging
Background:
- Fracture-related infection (FRI) is a common complication, often diagnosed late, hindering effective treatment.
- Previous studies on FRI have lacked precise infection definitions, limiting their value.
- Accurate diagnosis is challenging, especially without obvious clinical signs of infection.
Purpose of the Study:
- To review the essential principles for diagnosing fracture-related infections.
- To highlight the contributions of various diagnostic methods to identifying FRI.
- To emphasize the importance of a clear definition and diagnostic protocols for FRI research.
Main Methods:
- Review of clinical signs, serum tests, and imaging modalities.
- Analysis of microbiological culture and molecular biology techniques.
- Evaluation of histological analysis in diagnosing FRI.
Main Results:
- A new definition for FRI, coupled with standardized protocols for imaging, microbiology, and histology, enhances diagnostic accuracy.
- Integrating clinical, serological, imaging, microbiological, molecular, and histological data provides a comprehensive diagnostic pathway.
- Improved diagnostic criteria facilitate better study design and understanding of infected fractures.
Conclusions:
- Accurate and timely diagnosis of FRI is paramount for successful treatment outcomes.
- A multidisciplinary approach combining various diagnostic tools is essential for definitive FRI diagnosis.
- Standardized definitions and protocols are key to advancing research and clinical management of fracture-related infections.
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