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. 2025 Jul 24;35(1):320.
doi: 10.1007/s00590-025-04444-9.

Identifying risk factors for systemic complications following fracture-related infection

Robin M Litten  1 , Doriann M Alcaide  2 , Robert W Rutz  2 , Elizabeth M Benson  2 , Karen J Carter  2 , Evan G Gross  2 , Ryan N McIlwain  2 , Alex R Heatherly  2 , Matthew T Yeager  2 , Joshua T Stripling  2 , Clay A Spitler  2 , Joey P Johnson  3
Affiliations

Identifying risk factors for systemic complications following fracture-related infection

Robin M Litten et al. Eur J Orthop Surg Traumatol. .

Abstract

Purpose: Fracture-related infection (FRI) is a serious complication of orthopedic trauma that can result in systemic complications affecting multiple organ systems. While diagnostic criteria have become standardized, predictors of systemic complications remain poorly understood. This study aimed to evaluate factors associated with the development of systemic complications following operative FRI management.

Methods: We conducted a retrospective cohort study at a single Level I trauma center from 2013 to 2021. Adult patients with postoperative FRI requiring hospitalization and surgical treatment were included. Patients required either six months of follow-up or development of a systemic complication before that point. Systemic complications included cerebrovascular accident (CVA), myocardial infarction (MI), acute respiratory distress syndrome (ARDS), deep vein thrombosis/pulmonary embolism (DVT/PE), acute kidney injury (AKI), sepsis, and mortality. Demographics, comorbidities, injury characteristics, lab values, and operative details were compared between patients with and without complications.

Results: A total of 281 patients with FRI were included, with 70 (24.9%) experiencing systemic complications. The mean age of patients with complications was significantly higher (51.7 years) compared to those without (43.8 years, p < 0.001). Systemic complications included sepsis (11.7%), AKI (8.2%), DVT/PE (5.0%), and mortality (2.5%). Patients with complications had higher body mass index (BMI) (31.6 kg/m2 vs. 29.5 kg/m2, p = 0.054), a greater prevalence of diabetes (30.0% vs. 16.1%, p = 0.011), cardiovascular disease (CVD) (42.9% vs. 23.2%, p = 0.002), chronic obstructive pulmonary disease (COPD) (20.0% vs. 4.7%, p < 0.001), prior CVA (11.4% vs. 1.4%, p < 0.001), chronic kidney disease (CKD) (18.6% vs. 3.3%, p < 0.001), and higher Charlson Comorbidity Index (CCI) (2.2 vs. 1.0, p < 0.001). No significant differences were observed in fracture characteristics, operative details, or preoperative laboratory values (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], albumin, prealbumin) between the groups. Multivariate analysis identified higher CCI as an independent risk factor for systemic complications (OR 1.83, 95% CI 1.31-2.57; p = 0.001).

Conclusion: Patient characteristics such as age, diabetes, CVD, COPD, CVA, CKD, and CCI differed significantly in patients with FRI who experienced systemic complications from those without. CCI was an independent risk factor for systemic complications following FRI.

Level of evidence: Patient characteristics such as age, diabetes, CVD, COPD, CVA, CKD, and CCI differed significantly in patients with FRI who experienced systemic complications from those without. CCI was an independent risk factor for systemic complications following FRI. III.

Keywords: Charlson comorbidity index; Fracture-related infection; Orthopedic trauma; Retrospective cohort study; Risk stratification; Systemic complications.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

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