Fracture-related infection: current methods for prevention and treatment

Expert Rev Anti Infect Ther. 2020 Apr;18(4):307-321. doi: 10.1080/14787210.2020.1729740. Epub 2020 Feb 19.


Introduction: Fracture-related infection (FRI) is a serious complication related to orthopedic trauma, both from an infectious disease and a surgical point of view. The lack of scientific data with respect to diagnostic criteria and treatment principles of this entity has hampered efforts for an evidence-based approach and, as such, practices to prevent and treat FRI are often extrapolated from peri-prosthetic joint infection (PJI) literature. Recently, consensus guidelines were developed with respect to prevention, diagnosis and treatment of FRI.Areas covered: This review will define FRI and approaches to prevent and treat this complication will be discussed, with an emphasis on antimicrobial and surgical considerations. Guidelines focusing on FRI will be highlighted and aspects of pre-clinical research with imminent translational potential described.Expert opinion: New strategies are currently under investigation to improve the outcome of this sometimes-devastating complication. Local delivery of antimicrobials seems to be a promising approach; however, further high-quality clinical research is necessary to demonstrate efficacy. Delivery mechanisms for local antimicrobials include polymethyl methacrylate, implant coatings, collagen fleece, hydrogels and ceramics. The reintroduction of antimicrobials such as bacteriophage therapy has demonstrated promise in the management of drug-resistant organisms.

Keywords: Fracture-related infection; bacteriophage; biofilm; fracture; infection; locally delivered antimicrobial; orthopedic; prevention; treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Anti-Infective Agents / administration & dosage*
  • Drug Delivery Systems
  • Drug Resistance, Microbial
  • Fractures, Bone / complications*
  • Fractures, Bone / microbiology
  • Humans
  • Osteomyelitis / diagnosis
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / microbiology
  • Practice Guidelines as Topic
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / drug therapy
  • Surgical Wound Infection / microbiology


  • Anti-Infective Agents