Are All Fracture-Related Infections the Same?

Fracture-related infection (FRI) is one of the most feared complications after musculoskeletal injuries since it has not only important clinical consequences, but also a significant socioeconomic impact. 1,2 Even though FRI is one of the oldest disease entities, it has only recently been defined. The establishment of a consensus definition for FRIs laid the foundation to develop diagnostic and treatment recommendations. 3 In a next step an international expert panel introduced a new FRI classification system with the aim to guide the decision-making process around the main treatment concepts and to enable scientific evaluation by comparison of results in clinical studies. 4 This classification is based on the term FRI and the three major elements are: Fracture (F), Related patient factors (R) and Impairment of soft tissues (I), and each element is stratified according to complexity. Fractures can be healed (F1) or unhealed (F2–5). Patients may be fully healthy (R1) or have 4 levels of compromise, with and without end-organ damage (R2–5). Soft tissue condition ranges from well vascularized and easily closed (I1) to major skin defects requiring free flaps (I4). In all three elements, the fifth level (F5, R5 or I5) describes a patient who has an unreconstructible bone, soft tissue envelope or is not fit for surgery.