Defining treatment outcome in fracture-related infections: A scoping review

The fracture-related infection (FRI) consensus definition, published in 2018, marked a crucial advance for clinical practice and research, enabling treatment standardization and better comparison of clinical studies. However, a lack of clear, standardized outcome parameters still impedes the evaluation of treatment success, potentially leading to a misreporting of treatment failure in current literature. This scoping review provides an overview of outcome parameters used in the current literature to describe treatment success or failure in FRI.

A comprehensive literature search across four databases (PubMed, Embase, Scopus and Web of Science) was performed. Studies that reported on treatment outcome in adults with long-bone FRI, published between 2018 and 2023, were eligible for inclusion. The primary outcomes were the reporting of the persistence, eradication or recurrence of infection as well as radiological and functional outcome and the need for a return to theatre for infection control. The secondary aim was to screen the current FRI literature for applied follow-up duration.

A total of 111 studies were included for analysis and synthesis. Only 15.3 % (17/111) of the included studies used a clear definition of treatment success and/or failure in their methodology. Despite a high general reporting (85.6 %; 95/111) of infection eradication, recurrence and/or persistence, only few studies defined these parameters accurately: 16.2 % for eradication (18/111), 15.3 % for recurrence (17/111), 0 % for persistence. Bone healing was reported by 90.9 % (101/111) of the studies, with a standardized approach of radiological evaluation in 64.4 % (65/101). In total, 76 studies (68.5 %) assessed functional outcome, whereas no standardized score set was used. Correspondingly, no standardized follow-up duration could be identified. An unplanned return to theatre was considered by 16.2 % of the studies (18/111) to report outcome.

This scoping review highlights the lack of standardized outcome reporting in FRI. A clear definition on outcome reporting in FRIs is urgently needed to promote comparability and transparency in clinical research.