Emerging concepts in the diagnosis and treatment of fracture-related infections

Fracture-related infections (FRIs) remain a significant challenge in orthopaedic trauma, as they are a consistent source of poor patient outcomes and elevated health care costs. FRIs have traditionally been diagnosed using findings from physical examination, blood tests, and advanced imaging, and the mainstay of treatment has been bony debridement, removal of hardware, and local and systemic antibiotic therapy. Although patients with FRIs were historically treated with IV antibiotics, randomized clinical trials have since demonstrated that oral antibiotics can be just as effective while mitigating the risks associated with prolonged IV antibiotics. Emerging biomarkers for infection, including molecular methods such as transcriptomics, proteomics, metabolomics, and next-generation sequencing, offer the ability to more precisely identify infection from a wider range of microbes. Fluorescence-guided debridement surgery presents a strategy to better visualize infected tissue and decrease surgeon reliance on subjective intraoperative findings. The purpose of this review is to present emerging tools and treatment algorithms that might be able to increase the accuracy and precision with which FRIs are diagnosed and managed.