PET/CT-guided navigation-assisted debridement for tibial fracture-related infection: a retrospective cohort study

Fracture-related infection (FRI) is a serious complication secondary to fractures. Debridement plays a decisive role in the treatment of FRI, but precise debridement remains a surgical challenge. In this study, [¹⁸F]FDG PET/CT-guided navigation-assisted debridement was applied to the treatment of tibial FRI, and its efficacy was compared with that of conventional surgical approaches. This novel technique holds promise for achieving accurate and complete debridement of FRI lesions.

A retrospective analysis was conducted on patients with tibial FRI treated at our hospital between April 2021 and April 2024. A total of 78 patients were enrolled and divided into a navigation group (37 cases) and a conventional group (41 cases). Both groups underwent the two-stage Masquelet technique surgery. In the navigation group, the first-stage debridement of the infectious focus was performed under the full-process intelligent digital orthopedic operating system (Navi-OR 1) using preoperative [¹⁸F]FDG PET/CT for lesion delineation, while in the conventional group, debridement was carried out based on the surgeon's experience. The primary outcome was infection recurrence rate. Secondary outcomes included visual analogue scale (VAS), self-rating anxiety scale (SAS), lower extremity functional scale (LEFS), and activities of daily living (ADL) scores.

The navigation group had a significantly lower infection recurrence rate than the conventional group (10.8% [4/37] vs. 29.3% [12/41]; χ² = 4.064, p = 0.044; absolute risk reduction: 18.5 percentage points; odds ratio: 0.293, 95% CI: 0.096 - 0.971). The mean follow-up duration was 29.5 ± 3.8 months (range: 24 - 37 months) for the navigation group and 31.0 ± 7.9 months (range: 24 - 56 months) for the conventional group. At the final follow-up, the navigation group demonstrated significantly better ADL and LEFS scores (p < 0.05) and significantly lower VAS and SAS scores (p < 0.05) compared with the conventional group.

PET/CT-guided navigation-assisted debridement appears to be a feasible surgical approach for tibial FRI, with potential benefits in reducing infection recurrence and improving functional outcomes. However, further prospective multi-center studies with standardized protocols are warranted to confirm its clinical utility.

This study is the first to apply PET/CT-guided navigation-assisted debridement surgery for tibial FRI, in which preoperative PET/CT assists in delineating the suspected infectious focus and intraoperative real-time guidance with an optical navigation system enables accurate and complete debridement of the infected lesion, maximizes preservation of healthy tissue, and significantly reduces the infection recurrence rate.