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Review
. 2020 Oct 26;5(10):614-619.
doi: 10.1302/2058-5241.5.190072. eCollection 2020 Oct.

Definition and diagnosis of fracture-related infection

Martin McNally  1 , Geertje Govaert  2 , Maria Dudareva  1 , Mario Morgenstern  3 , Willem-Jan Metsemakers  4
Affiliations
Review

Definition and diagnosis of fracture-related infection

Martin McNally et al. EFORT Open Rev. .

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.

Keywords: definition; diagnosis; fracture; fracture-related infection (FRI); histopathology; medical imaging; microbiology; serum inflammatory markers.

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Conflict of interest statement

ICMJE Conflict of interest statement: MM reports textbook royalties from Oxford University Press; expenses paid for travel and accommodation to attend symposia or expert panels from Bonesupport AB, outside the submitted work. GG reports being a board member of the Dutch Trauma Society, and a research grant for prospective imaging trial (the IFI trial) from DePuy-Synthes, outside the submitted work. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
The diagnostic algorithm for a suspected fracture-related infection (FRI), using the updated definition criteria of the FRI Consensus Group. Note. NP/HPF, neutrophils per high-power field (x 400 magnification).

  1. Any of these criteria will diagnose the presence of an infection independently. For instance, the presence of a draining sinus communicating with the fracture does not need microbiological culture for confirmation of infection.

  2. Suggestive criteria should prompt the surgeon to consider further investigations which may lead to identifying possible confirmatory criteria.

  3. A single positive culture from sonication fluid at >50 colony-forming units per ml, particularly from a virulent organism, such as Staph. aureus, is highly suggestive of infection and may be taken as confirmatory on an intention-to-treat basis.

  4. >5NP/HPF is regarded as confirmatory of infection in cases more than 8 weeks after fracture.

See this image and copyright information in PMC

References

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