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Textbook/Musculoskeletal medicine and orthopaedics/Fracture-related and metalwork infection/Rapid
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Fracture-related and metalwork infection

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Sepsis and unstable infected fixation require immediate assessment

Fracture-related infection can present as an acute leaking wound or late infected non-union; systemic illness, deep abscess, implant failure and compromised cover threaten life, limb and the mechanical pathway to union.

Action: If septic, obtain blood cultures and give parenteral antibiotics immediately while arranging drainage. If stable, withhold empirical therapy, obtain consultant review within 48 hours, define union, fixation, perfusion and soft tissue, and plan five deep cultures, debridement, stability and coverage through the bone-infection multidisciplinary team.

Synopsis

Recognise confirmatory and suggestive infection around fracture fixation, protect diagnostic yield, integrate union, stability, biofilm and soft-tissue decisions, and coordinate debridement, implant strategy and culture-directed therapy.

  • A sinus, fistula or wound breakdown communicating with the fracture or implant, or purulence at surgery, is confirmatory evidence of fracture-related infection.
  • Suggestive features include persistent drainage, redness, swelling, fever, increasing pain, radiographic loosening, lysis, non-union and new effusion; they trigger investigation rather than proving infection alone.
  • Septic patients receive immediate assessment, blood cultures and parenteral antibiotics. Stable patients should have consultant review within 48 hours and no empirical antibiotics before that review.

Key red flags

Shock, spreading erythema, rapidly increasing drainage or deep fluctuance requires immediate medical and surgical source-control assessment and antibiotics after blood cultures.

Investigation priorities

01
Initial plain radiographsFirst step

Assess union, alignment, lysis and implant integrity.

Management branches

SepticTreat systemic danger and drain

Organ dysfunction, bacteraemia or rapidly progressive fracture-site infection is present.

  1. Obtain blood cultures, start parenteral therapy and call orthopaedic, anaesthetic and infection teams immediately.
  2. Protect unstable fixation and assess perfusion, soft tissue and deep collections urgently.
StablePreserve diagnosis and plan reconstruction

Drainage, pain, loosening or non-union suggests infection without systemic illness.

Key medicines

Post-sampling broad-spectrum therapyAfter five deep cultures and indicated histology, give the full adult fracture-related-infection protocol regimen and review it at 48 hours with preliminary results; in sepsis, give parenteral therapy after rapid blood cultures even if deep sampling must follow.
Directed implant-associated regimenUse the narrowest organism-active regimen with exact dose, route, monitoring and duration agreed by the infection specialist after culture review, adding any biofilm-active component only for a susceptible organism and a deliberate retained-implant strategy.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom