DIAGNOSTIC AND THERAPEUTIC STRATEGIES IN PERIPROSTHETIC FRACTURE-RELATED INFECTIONS (PFRI): CASE SERIES AND LITERATURE REVIEW

Aim Periprosthetic Fracture Related Infections (PFRI) are a serious complication of total arthroplasty, with incidence rates increasing in line with the growing number of joint replacements. PFRI can lead to prolonged hospitalization, multiple surgical procedures, and suboptimal functional outcomes. The diagnosis of PFRI remains challenging due to the overlap of clinical symptoms with other post-traumatic conditions, and identification of the pathogen often fails through conventional methods. The aim of this study is to analyze clinical cases of PFRI, assess diagnostic tools, therapeutic strategies, and compare them with existing literature to improve management approaches. Methods This retrospective case series was conducted at the Unit of Osteoarticular Infection of the University of Turin, Italy, from January 2018 to December 2023. Patients who developed septic complications after open reduction and internal fixation (ORIF) of periprosthetic fractures involving hip or knee implants were included. The infection was diagnosed in accordance with established guidelines, and treatment decisions were based on clinical, microbiological, and radiological findings. Results In the present study, PFRI were identified in nine patients (5.4%), constituting a small but significant subset of cases. The cases were then categorized into four clinical scenarios based on the following variables: joint involvement, fracture healing, and infection progression. Scenario A, involving fractures without prosthetic involvement and unhealed fractures, included 2 patients (22%) and was treated with debridement and change of the fixation device. Scenario B, involving fractures without prosthetic involvement but with healed fractures, involved 1 patient (11%), where the ongoing infection was confirmed despite the healed fracture and where the device could be removed. The third scenario (C), which pertains to cases involving prosthetic involvement, included 4 patients (44%) who required replacement or removal of the prosthesis and, in some cases, a second stage. The fourth scenario, involving patients with limited operability, included two patients (22%) for whom no surgery was performed. Despite the significant clinical challenges encountered, the paucity of literature on the management of periprosthetic fractures with septic complications is limited, highlighting the need for further research in this understudied area. Conclusion PFRI remains a challenging complication that necessitates a multidisciplinary approach to diagnosis and treatment. Despite advances in imaging and microbiological testing, the early detection and identification of pathogens remains challenging, emphasizing the necessity for enhanced diagnostic methods. This study offers valuable insights into the management of PFRI and provides a foundation for future research to develop optimal diagnostic and therapeutic strategies.