Debridement, antimicrobial therapy and implant retention (DAIR) The most important factor for choosing implant retention is a stable fracture with a high likelihood of union. In such cases, a debridement, antimicrobial therapy and implant retention (DAIR) procedure might be feasible. However, this does NOT mean that debridement is somehow easier. An extensive and adequate debridement […]
Preferable assessed after debridement , the FRI classification is a useful tool for guiding clinicians to make a personalized treatment plan after sampling and debridement, based on the three major elements: Fracture (F), Related patient factors (R) and Impairment of soft tissues (I). Fracture (F) treatment Fracture stabilization is essential for successful treatment. An unstable […]
Adequate debridement remains one the the most challenging and most important elements of the treatment of open fractures and FRI. The presence of a plastic surgeon capable of replacing non-vital tissue with healthy tissue (both for soft tissue and bone) makes the debridement easier and more effective. The best outcomes are probably being achieved when […]
If FRI is suspected, do not start antibiotic treatment before a diagnostic workup, unless the patient is systemically ill, or in situations when a diagnostic workup is not possible. Providing antibiotics to patients with FRI without cultures and antibiograms will lead to inadequate treatment and antibiotic resistance development. Which pathogens cause FRI? The most common […]
Understanding the basic principles for the treatment of FRI will help you develop a structured approach. FRI treatment principles Before treating a patient with FRI, consider the following elements: Adjust targeted antimicrobial therapy based on culture results. While the focus tends to be on the technical aspects of the treatment and specific antibiotic regimens, you […]
FRI classification is helpful to compare patients for research and to guide clinicians in decision-making when treating patients with a standardized treatment strategy. There are several classifications (Cierny-Mader, BACH) that can help to understand FRI. However, these classification systems were developed before the destinction between FRI and oestomyelitis was made, limiting their usefullness in clinical practice […]
FRI should be suspected in cases of poor bone healing, poor soft tissue coverage, sinus formation, or persistent pain. The diagnosis of FRI can be challenging in certain situations without clear signs of infection.There are a few things to keep in mind before assessing a patient with suspected FRI: Firstly, patients with signs of systemic […]
Open fractures have a increased risk of developing FRI, with rates between 12–52% of all open fractures in low resource setting. Effective initial management is critical in reducing this risk by removing as much primary contamination as possible while at the same time preventing iatrogenic introduction of pathogens. Prompt washout and early administration of antibiotics […]
A fracture-related infection (FRI) is a serious complication of a fracture. They can occur in open or closed fractures, particularly in fractures that were treated with open reduction and internal fixation. Presentation of Fracture-Related Infection (FRI) across Mild, Moderate, and Severe Stages Around 1.8 Around 1.8 million FRIs occur globally each year. Rates are expected […]
