• Markus Rupp, Nike Walter, Susanne Bärtl, Robert Heyd, Florian Hitzenbichler, and Volker Alt.
• Department for Trauma surgery, University Hospital Regensburg, Germany; Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Germany; Department for Hospital hygiene and Infectiology, University Hospital Regensburg, Germany.
• Dtsch Arztebl Int. 2024 Jan 12; 121 (1): 172417-24.

BackgroundFracture-related infection (FRI) is a challenge to physicians and other workers in health care. In 2018, there were 7253 listed cases of FRI in Germany, corresponding to an incidence of 10.7 cases per 100 000 persons per year.MethodsThis review is based on pertinent publications retrieved from a search in PubMed with the search terms "fracture," "infection," "guideline," and "consensus." Aside from the primary literature, international guidelines and consensus recommendations were evaluated as well.ResultsFRI arise mainly from bacterial contamination of the fracture site. Staphylococcus aureus is the most commonly detected pathogen. The treatment is based on surgery and antibiotics and should be agreed upon by an interdisciplinary team; it is often difficult because of biofilm formation. Treatment options include implant-preserving procedures and single-stage, two-stage, or multi-stage implant replacement. Treatment failure occurs in 10.3% to 21.4% of cases. The available evidence on the efficacy of various treatment approaches is derived mainly from retrospective cohort studies (level III evidence). Therefore, periprosthetic joint infections and FRI are often discussed together.ConclusionFRI presents an increasing challenge. Preventive measures should be optimized, and the treatment should always be decided upon by an interdisciplinary team. Only low-level evidence is available to date to guide diagnostic and treatment decisions. High-quality studies are therefore needed to help us meet this challenge more effectively.

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