Assessment of Incidence and Associated Risk Factors of Fracture-Related Infection in Patients Undergoing Internal Fixation of Long Bone Fractures

Abstract

Background: Fracture-related infection (FRI) is a major complication following internal fixation of long bone fractures and is associated with delayed fracture healing, repeated surgical interventions, prolonged hospitalization, and increased healthcare expenditure. Identification of associated risk factors is essential for developing effective preventive strategies. Objectives: To assess the incidence of fracture-related infection and evaluate the associated patient-related, injury-related, and operative risk factors among patients undergoing internal fixation of long bone fractures. Materials and Methods: A prospective observational study was designed involving 120 adult patients undergoing internal fixation of long bone fractures. Demographic characteristics, comorbidities, fracture characteristics, surgical duration, timing of fixation, and postoperative outcomes were evaluated. Fracture-related infection was defined according to internationally accepted consensus criteria. Associations between potential risk factors and infection were assessed using appropriate statistical methods. Results: The provisional dataset included 14 patients (11.7%) with FRI. Infection occurred in 31.3% of open fractures compared with 4.5% of closed fractures. Diabetes mellitus (crude OR 5.24), current smoking (OR 5.27), obesity (OR 3.97), open fractures (OR 9.55), prolonged operative duration (OR 5.29), and delayed definitive fixation (OR 3.98) demonstrated higher crude odds of infection. Staphylococcus aureus was the most frequently recorded microorganism. Repeat surgical intervention was recorded in 85.7% of patients with FRI. Conclusion: Fracture-related infection following internal fixation of long bone fractures is associated with multiple patient-related, injury-related, and operative factors. Recognition of high-risk patients, appropriate soft tissue management, optimization of modifiable risk factors, and structured postoperative surveillance are important for reducing infection-related morbidity.

Keywords: Fracture-related infection; Long bone fractures; Internal fixation; Open fractures; Risk factors; Surgical infection; Orthopaedic trauma.