Multidisciplinary Treatment of Fracture-Related Infection Has a Positive Impact on Clinical Outcome—A Retrospective Case Control Study at a Tertiary Referral Center

Abstract

Objectives: Fracture-related infection (FRI) is a major complication in orthopedic and trauma surgery. The management and choice of treatment can be difficult depending on multiple factors. Therefore, we implemented a weekly multidisciplinary team discussion to determine diagnostic and treatment strategies in FRI patients and aimed to analyze its effect on clinical outcomes. Methods: Clinical outcomes of FRI patients treated before and after implementation of a structured multidisciplinary treatment (MDT) approach with a weekly case discussion were compared at a follow-up of 12 months. Results: In total, n = 117 were eligible for enrolment, whereby n = 58 patients (72.4% male, mean age 56.7 ± 16.8 years) constituted the MDT group and n = 59 patients (72.9% male, mean age 55.0 ± 16.5 years) the control group. In the MDT group more cases were treated with local antibiotics (67.2% vs. 27.1%, p < 0.001) and significant less amputations (3.4% vs. 6.8%, p = 0.014), as well as less revision surgeries (1.5 ± 1.2 (0–5) vs. 2.2 ± 1.2 (0–7), p = 0.048) were performed. A trend towards less debridement, antibiotics and implant retention (DAIR) procedures, lower rates of recurrence of infection and less treatment failures in the MDT group was observable, even though not statistically significant. Conclusion: An MDT approach providing a patient tailored treatment concept in the treatment of FRI patients appears to be beneficial for the affected patients. Quality and efficacy of implemented MDT meetings should further be evaluated to provide sufficient evidence to further implement this valuable tool in clinical practice and decision making.

The patients‘ perspective - a qualitative analysis of experiencing a fracture-related infection

“…Hence, randomized-controlled trials to address this aspect are urgently required. Further, while in other disciplines such as oncology, tumor boards are well-established and proven beneficial, the role of multidisciplinary teams in bone and joint infection management has only recently been scientifically looked at ( Rupp et al, 2023 ). The presented results encourage collaborative approaches and deem the presence of a psychologist as part of the treatment team as warranted.…”

“…Also, in the case of FRI treatment, the complexity of factors to be considered for optimal management can sometimes surpass the experience of even skilled orthopedic and trauma surgeons. Thus, it is crucial to involve multidisciplinary specialists and to consider the patient’s psychological response to the trauma and the subsequent infectious complication ( Rupp et al, 2023 ).…”

Improving the Care of Severe, Open Fractures and Postoperative Infections of the Lower Extremities: Protocol for an Interdisciplinary Treatment Approach

“…Interdisciplinary support can shorten hospital stays and reduce costs [70]. Patient-tailored treatment and multidisciplinary support shortens hospital stays, and an interdisciplinary approach reduces treatment costs [71]. Multidisciplinary approach and early diagnosis crucial for treatment success.…”

Managing more than bones: the psychological impact of a recurrent fracture-related infection

“… 10 , 11 Recent consensus regarding the definition of FRI offers clarity, yet effective management remains intricate, necessitating interdisciplinary collaboration and comprehensive guidelines. 12 Surgical objectives encompass infection eradication and restoration of bone integrity and stability, often entailing multistage interventions. 13 Moreover, the recurrence of FRI presents a particularly concerning scenario, potentially leading to greater morbidity, prolonged treatment courses, and heightened psychological distress.…”