Objective To review the current research status on the diagnosis and treatment of fracture-related infection (FRI). Methods The research literature in the field of FRI both domestically and internationally in recent years were widely reviewed, and the research progress of FRI from the aspects of definition and classification, epidemiological characteristics, diagnosis and treatment elaborated, in order to provide reference for clinical practices. Results In recent years, specific classifications for FRI have gradually emerged. FRI is characterized by high incidence, high recurrence, high disability rates, and significant economic costs. Key diagnostic points include clinical signs and symptoms, imaging tests, serological biomarkers, pathogen identification, and histopathological examination. Treatment principles encompass debridement, management of implants (retention or removal), systemic and local antibiotic use, reconstruction of bone and soft tissue defects, and functional and psychological rehabilitation. Conclusion Although FRI is a catastrophic complication following limb bone trauma, early precise diagnosis and standardized treatment are key to improving cure rates, reducing recurrence, and enhancing patients’ quality of life.
Objective To summarize the clinical experiences of using Zeta-focal bone lengthening to treat bone defects caused by fracture-related infection (FRI) in two cases, and to preliminarily explore its feasibility and efficacy. Methods In 2023, two male patients with bone defects caused by FRI were treated, aged 19 and 40 years, respectively. After admission, stage Ⅰ treatment consisted of thorough debridement and infection control based on bacterial culture and drug susceptibility test results. The lengths of bone defects were 6 cm and 22 cm, respectively. When the erythrocyte sedimentation rate and inflammatory markers returned to normal ranges, stage Ⅱ treatment (debridement and reconstruction with Zeta-focal bone lengthening) was performed. Distraction was initiated at 7 days after the second-stage operation. Docking of the bone segments was achieved at 11 and 40 days of distraction, respectively, and obvious mineralization in the distraction zones was observed at 65 and 104 days postoperatively. The external fixator was removed after radiographic evidence of cortical continuity at four sites was confirmed on anteroposterior and lateral X-ray films. The external fixation time was 112 and 357 days, respectively, and the external fixation indexes were 18.5 and 17.9 days/cm, respectively. Complications during the distraction period were observed. During follow-up, bone healing and functional recovery were evaluated with the Paley D score, the Association for the Study and Application of the Method of Ilizarov (ASAMI) score, the Lower Extremity Functional Scale (LEFS), and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Results Both patients completed the two-stage treatment. Their hospital stays were 21 and 16 days, respectively. Only mild pin-tract reactions occurred during the distraction period. Both patients were followed up for 18 months. At last follow-up, 2 patients achieved excellent functional results according to the ASAMI score, and bone healing was rated as excellent by the Paley D score. In 1 patient, the LEFS score was 76 and the AOFAS score was 95. The other patient was not scored because of knee arthrodesis. Conclusion Under the prerequisites of strict infection control and individualized segmental design, Zeta-focal bone lengthening can achieve effective reconstruction of infectious bone defects and significantly reduce the external fixation time and the external fixation index.