Zalavras, Charalampos G., 2022. CORR Insights®: Isothermal Microcalorimetry Improves the Time to Diagnosis of Fracture-related Infection Compared With Conventional Tissue Cultures. Clin. Orthop. Relat

abstract

Fracture-related infection is a challenging complication for patients, resulting in considerable morbidity. It compromises fracture healing, requires one or more additional surgeries, and delays a patient’s return to function. The diagnosis of fracture-related infection is often elusive. Clinical symptoms and signs may be absent or overlap with the signs of trauma initially, as well as with the signs of nonunion and posttraumatic changes later on. In addition, the results of preoperative laboratory tests and imaging may suggest a diagnosis, but are not able to establish it. Intraoperative cultures are often relied upon to make the diagnosis, but they are not perfectly reliable. These challenges resulted in the absence of an agreed-upon definition of fracture-related infection, until recently. To standardize the criteria for the diagnosis of fracture-related infection, an international expert group created a consensus definition that recently was validated. The consensus definition distinguishes criteria into suggestive (infection may be present) and confirmatory (infection is definitely present). Intraoperative cultures have traditionally been the mainstay of diagnosis, and the presence of the same organism in two separate deep cultures is a confirmatory criterion for fracture-related infection. However, approximately 10% of infections are culture-negative, and in culture-positive infections, the results are not available until days (or even weeks) after the procedure.

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