Doležalová Hrubá Michaela, Zídek Tomáš, Kloub Martin, Urban Jiří
Department of Trauma Surgery, České Budějovice Hospital, B. Němcové 585/54, 370 01, České Budějovice, Czechia; Charles University, Faculty of Medicine in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen 1, Czechia.
Department of Trauma Surgery, České Budějovice Hospital, B. Němcové 585/54, 370 01, České Budějovice, Czechia; Charles University, Faculty of Medicine in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen 1, Czechia.
Injury. 2025 Aug;56(8):112519. doi: 10.1016/j.injury.2025.112519. Epub 2025 Jun 4.
A Fracture-related infection (FRI) is a rare but serious complication of surgical fracture treatment in children and adolescents. Exact data on the incidence of FRI in children and adolescents are not available in the literature. In adults, criteria for the diagnosis and treatment of FRI were published in 2018 by an expert group and divided into suggestive and confirmatory categories. However, there is no recommended approach for diagnosing and treating FRI in children or adolescents.
This study aimed to determine the incidence of FRI in children and adolescents who underwent operative fracture treatment at a Level I trauma center between 2019 and 2023, to evaluate age distribution, anatomical sites and bacterial spectrum of FRI in children and adolescents, to evaluate risk anatomical locations and initial fracture treatment methods in relation to the development of FRI and to assess the applicability of FRI diagnostic criteria in the pediatric patients.
It is a retrospective monocentric study conducted by reviewing hospital database. The study included all patients under 18 years of age with present growth plates who underwent surgical fracture treatment between 2019 and 2023.
The incidence of FRI in children was 0,95 % among 1156 osteosynthesis procedures performed between 2019 and 2023. The average age of pediatric patients with FRI was 11,18 years. The most common anatomical site of FRI in out cohort was the forearm (36,36 %). High-risk locations in terms of developing FRI relative to the number of osteosyntheses performed included the proximal femur (20 %) and the diaphysis of the humerus (7.69 %). The most common pathogen causing FRI in children was S. aureus (63,6 %). On average, 2.1 additional surgical procedures were required to eradicate the infection.
FRI in children is a rare but serious complication, which most commonly occurs in the upper extremity, specifically in the forearm area. However, some anatomical sites with a lower incidence of fractures demonstrate a significantly higher relative risk for the development of FRI. The recommended guidelines developed in 2018, including diagnostic criteria for FRI, can be successfully applied to the pediatric population.
