Diagnosis and Evaluation of Fracture-Related Infection

Following fracture fixation, fracture-related infection (FRI) is a common complication and requires systematic evaluation to allow for an optimal treatment strategy. A high index of suspicion is necessary for early and timely diagnosis, to diagnose occult infection, and to prevent untreated infections from worsening. Diagnosis of FRI includes evaluation based on history and clinical examination, surgical exploration, serum inflammatory markers, imaging modalities, microbiology, histopathology, and, when needed, molecular biology. FRI can be early, delayed, or late onset, and symptom presentation and the pathogenic organism may vary with each type. Key considerations during the evaluation of FRI include if the fracture has united, the onset of symptoms, the location of the infection, the stability of fixation, the quality of reduction, the quality of soft tissues, history of infection, and host physiology. Although the common treatment for early FRI includes débridement, implant retention, and antibiotics, the treatment for delayed-onset or late-onset FRI typically includes staged surgeries starting with removal of implants and antibiotic treatment.