Mehrdad Zamani Esfahlani
1 
, Meisagh Asanjani Oskoii
1 , Sina Najafi
2, Ali Maavaeian
3* 1 Department of Orthopedics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Infectious Disease, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
3 Bone, Joint, and Related Tissues Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Fracture‑related infection (FRI) remains one of the most consequential complications in orthopedic trauma, imposing effects that extend far beyond localized tissue involvement to include substantial systemic morbidity and notable socioeconomic burden. Its clinical urgency is underscored by a highly variable incidence—ranging from 1%–2% in closed fractures to more than 30% in severe open injuries—and by its detrimental impact on bone healing, functional recovery, and overall quality of life. This literature review synthesizes current knowledge on the epidemiology and clinical significance of FRI, emphasizing incidence patterns, associated functional limitations, long‑term risks such as nonunion, amputation, and mortality, and the considerable health‑economic implications. Persistent challenges in early diagnosis are highlighted, including nonspecific clinical presentations, inconsistencies in temporal classifications, and the limited ability of available treatments to simultaneously eradicate infection and maintain mechanical stability. Contemporary management strategies—such as debridement, antibiotics, and implant retention (DAIR); staged hardware removal; systemic antimicrobial therapy; and adjunctive local antibiotic‑delivery systems—are examined with attention to their evidence gaps and recognized failure points. In addition, emerging modalities that target the underlying pathophysiology of FRI are reviewed, including biofilm‑disruptive agents, biodegradable antibiotic carriers, antimicrobial implant coatings, and bacteriophage‑based approaches, each offering mechanistic advantages over conventional interventions. Collectively, the current evidence underscores the critical need for standardized diagnostic criteria, timely multidisciplinary management, and rigorous clinical evaluation of innovative therapeutic strategies to improve outcomes, reduce recurrence, and optimize fracture healing in early FRI.