Fracture-related infection: A consensus on definition from an international expert group.
Metsemakers WJ, Morgenstern M, McNally MA, et al. Injury 2018 · PMID 28867644 · doi:10.1016/j.injury.2017.08.040
- Question
- How should infection after fracture fixation be defined consistently for clinical care and research?
- Design
- International expert consensus supported by the AO Foundation, built on a systematic literature review, a survey of AOTrauma surgeons and an expert panel meeting.
- Patients
- Patients with suspected infection after fracture, with or without fixation.
- Intervention
- Confirmatory and suggestive criteria for fracture-related infection
- Comparison
- Previous use of surgical site infection definitions
- Primary outcome
- Consensus definition (no single trial outcome)
- Key result
- Defined confirmatory criteria (fistula, sinus or wound breakdown communicating with bone or implant; purulent drainage or pus; the same pathogen in at least two deep tissue samples; microorganisms on histology) and suggestive criteria (clinical signs, raised markers, imaging, single positive culture) that should prompt further investigation.
- Limitations
- Consensus rather than validation data; suggestive criteria and inflammatory markers have limited specificity in the post-operative period.
- Impact on practice
- Standard terminology for FRI in UK trauma and bone infection units; emphasises multiple deep tissue samples rather than superficial swabs.