Diagnosis and management of fracture-related infections in a low-income country: a prospective study comparing current practice to international consensus guidelines.
(2026) Journal of bone and joint infection — Vol. 11, n° 1, p. 53-63 (2026)
Files
2026_Fonkoué_J_Bone_Jt_Infect.pdf
Open Access - Adobe PDF
- 918.02 KB
Details
- Authors
Tissingh, Elizabeth K 
McNally, Martin
- Abstract
- 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.
- Affiliations
Citations
Fonkoue, L., Tissingh, E. K., Ngang, C., Kennedy Muluem, O., Simo, J. S., Douvamai, R., Bahebeck, J., Cornu, O., & McNally, M. (2026). Diagnosis and management of fracture-related infections in a low-income country: a prospective study comparing current practice to international consensus guidelines. Journal of bone and joint infection, 11(1), 53-63. https://doi.org/10.5194/jbji-11-53-2026 (Original work published 2026)