Fracture-Related Infection Diagnostic Tools in the Upper Extremity: A Scoping Review.

Abstract

Fracture-related infection (FRI) is a serious orthopaedic complication and its diagnosis, particularly in the upper extremity, is difficult and poorly defined in current literature. An international consensus definition of FRI was published in 2018, and our scoping review aims to investigate FRI diagnostic tools reported in the primary literature and their biostatistical utility. A review of articles generated from the PubMed/NCBI search term "fracture-related infection" was undertaken using PRISMA methodology. The included studies were published from January 2018 to June 2022 and referred to FRI diagnosis in the upper extremity. Of 224 returned studies, 32 articles were selected for further review after fellowship-trained senior author assessment. Of these, 16 had quantitative and reportable data regarding the diagnosis of upper extremity FRI. The most common diagnostic methods reported were CRP (8 studies), WBC (7), and ESR (5), consistent with 1 of the six suggestive criteria from the consensus definition. Meta-analysis was performed. Primary literature regarding the diagnosis of upper extremity fracture-related infections is sparse and variable despite FRI's diagnostic and therapeutic complexity. Recent literature does not reflect the proposed criteria of the 2018 consensus definition; further primary research is needed to validate these criteria and their accuracy and utility Level of Evidence: 3b.