Fracture-Related Infection (FRI): Diagnostics, Classification, and Decision-Making

Fracture-related infection (FRI) remains one of the most challenging complications in musculoskeletal trauma surgery, occurring in up to 30% of open fractures. It is associated with significant patient morbidity, prolonged hospitalization, high healthcare costs, and, in severe cases, permanent disability or amputation. While historical management was hampered by the lack of a standardized definition, the development of the AO Foundation and European Bone and Joint Infection Society (EBJIS) consensus guidelines has revolutionized clinical approach. By categorizing diagnostic features into suggestive and confirmatory criteria, clinicians can now diagnose and treat FRIs with unprecedented precision.

However, translating these criteria into standardized, daily clinical practice and navigating complex treatment algorithms remains a major hurdle. Successful management of FRI depends on a multifactorial clinical picture, including the stability of the fracture, the quality of the surrounding soft-tissue envelope, the duration of the infection, and host-related risk factors. Orthopedic trauma surgeons must make critical decisions regarding implant-sparing strategies, radical debridement, local and systemic antimicrobial therapy, and soft-tissue reconstruction. Furthermore, emerging intraoperative diagnostic modalities and advanced microbiological techniques are shaping the future of early FRI detection.

This Research Topic aims to compile high-quality research that advances our understanding of FRI diagnostics, refines classification models, and provides evidence-based decision-making frameworks. We welcome contributions that explore the clinical validation of current guidelines, compare diagnostic protocols, and report on treatment outcomes in orthopedic trauma.

Sub-themes of interest include, but are not limited to:

Validation and refinement of the AO/EBJIS consensus definition for FRI.

Clinical utility of novel biomarker and microbiological diagnostic assays.

Surgical decision-making pathways: implant retention (DAIR) versus implant exchange.

Advanced soft-tissue reconstruction techniques in the presence of active infection.

Novel local antibiotic carriers and systemic antimicrobial protocols.

Outcomes of multidisciplinary treatment approaches and team-led interventions.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

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Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Fracture-Related Infection (FRI), Soft-Tissue Impairment, Surgical Decision-Making, Implant Retention, Trauma Reconstruction

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.