Diagnosis and management of fracture-related infections in a low-income country: a prospective study comparing current practice to international consensus guidelines

Journal article

Data on the implementation of international consensus guidelines for fracture-related infection (FRI) in low- and middle-income countries (LMICs) are scarce. This study assessed whether FRI diagnosis and management in an LMIC align with these recommendations. Methods: We conducted a prospective multicenter study across four tertiary hospitals in Yaoundé, Cameroon (September 2022-July 2025). All consecutive patients with a working FRI diagnosis were included. Confirmatory/suggestive diagnostic criteria and treatment strategies were assessed against consensus guidelines. Results: A total of 169 patients were included (mean age 39.4 ± 15.4 years; 72.7 % male). In 34.3 % of cases, FRI occurred without prior surgery, limiting applicability of the Willenegger and Roth classification. Clinical confirmatory criteria were present in 97 % of cases. Microbiological standards were seldom achieved: none fulfilled sampling quantity, and only 46.6 % met sampling method recommendations. A microbiological confirmatory criterion was documented in 36 patients (21.3 %); histopathology was rarely performed (1.2 %), and nuclear imaging was not used. Most patients (81.1 %) were on antibiotics before admission or surgery. The most common treatment strategies were suppressive antibiotic therapy (44.4 %); one-stage (11.2 %) or two-stage (10.7 %) debridement, antibiotics, and implant exchange (DAIEX); and debridement, antibiotics, and implant retention (DAIR; 9.5 %). Overall, 62.7 % of treatments deviated from consensus guidelines. Conclusion: Nearly two-thirds of FRIs in this LMIC setting were managed outside international consensus guidelines. While the consensus definition is applicable, diagnostic capacity remains limited and microbiological standards are often impractical. Context-adapted, evidence-based guidelines are urgently needed to improve outcomes where the burden is highest.

Authors: Fonkoué, L; Tissingh, EK; Ngang, C; Kennedy Muluem, O; Simo, JS

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Copernicus Publications
• Journal: Journal of Bone and Joint Infection
• Volume: 11
• Issue: 1
• Pages: 53-63
• Publication date: 2026-01-29
• DOI: 10.5194/jbji-11-53-2026
• EISSN: 2206-3552
• ISSN: 2206-3552
• Pmid: 41635754
• Language: English
• Keywords: Prospective cohort study; Limiting; Sampling (signal processing); MEDLINE; Evidence-based medicine; Clinical Practice