Table 3.

Key recommendations

A well-established diagnosis is the first step in the treatment process of FRI patients. The presence of confirmatory signs should prompt treatment for FRI. Suggestive signs should motivate the medical team to further investigate the probability of an FRI A multidisciplinary approach is a key aspect in FRI treatment and should be implemented. The exact composition of the MDT will depend on the patient’s needs and local preferences It is recommended to refer complex cases to specialized centers where an MDT is available and physicians are experienced with the treatment of FRI The patient’s health status should be optimized. Optimization strategies should be started in consultation with the MDT and preferably preoperatively, if the clinical status allows it Patients who are nutritionally at risk for malnutrition should be considered for screening and, depending on the severity, a multidisciplinary approach (e.g. endocrinologists, nutritionists, geriatrics) for the optimization of this status should be implemented Fracture stability is of key importance with respect to the surgical treatment of FRI Thorough debridement is essential as well as adequate management of the dead space that may be created Low-pressure irrigation should be performed with a sufficient amount of normal saline in order to thoroughly clean the surgical field and to lower the bacterial load The application of local antimicrobials should be strongly considered NPWT should only be used as a short bridge to definite soft tissue coverage In case of FRI, start empiric broad-spectrum antibiotic therapy after tissue sampling A minimum follow-up of 12 months after cessation of (surgical and antibiotic) therapy is recommended, with the follow-up frequency depending on local policies and preferences Standardized patient outcome measures for FRI are currently not available. PROMIS seems to be the preferred tool to assess the patients’ short and long-term outcome

FRI fracture-related infection, MDT multidisciplinary team, NPWT negative-pressure wound therapy, PROMIS patient-reported outcomes measurement information system