TY - JOUR
T1 - The FRI classification – A new classification of fracture-related infections
AU - Alt, Volker
AU - McNally, Martin
AU - Wouthuyzen-Bakker, Marjan
AU - Metsemakers, Willem Jan
AU - Marais, Leonard
AU - Zalavras, Charalampos
AU - Morgenstern, Mario
N1 - Publisher Copyright:
© 2024
PY - 2024/11/1
Y1 - 2024/11/1
N2 - Aim: To identify the most relevant factors with respect to the management of fracture-related infection (FRI) and to develop a comprehensive FRI classification that guides decision-making and allows scientific comparison. Method: An international group of FRI experts determined the preconditions, purpose, primary factors for inclusion, format and detailed description of the elements of an FRI classification through a consensus driven process. Results: Three major elements were identified and grouped together in the FRI Classification: Fracture (F), Related patient factors (R) and Impairment of soft tissues (I). Each element was divided into five levels of complexity. Fractures can be healed (F1) or unhealed (F2–5). Patients may be fully healthy (R1) or have 4 levels of compromise, with and without end-organ damage (R2–5). Soft tissue condition ranges from well vascularized and easily closed (I1) to major skin defects requiring free flaps (I4). In all three elements, the fifth level (F5, R5 or I5) describes a patient who has an unreconstructible bone, soft tissue envelope or is not fit for surgery. Conclusion: The FRI classification, which is based on the three major elements Fracture (F), Related patient factors (R) and Impairment of soft tissues (I) is intended to guide decision-making and improve the quality of scientific reporting for FRIs in the future. The proposed classification is based on expert opinion and therefore an essential next step is clinical validation, in order to realize the ultimate goal of improving outcomes in the management of FRI.
AB - Aim: To identify the most relevant factors with respect to the management of fracture-related infection (FRI) and to develop a comprehensive FRI classification that guides decision-making and allows scientific comparison. Method: An international group of FRI experts determined the preconditions, purpose, primary factors for inclusion, format and detailed description of the elements of an FRI classification through a consensus driven process. Results: Three major elements were identified and grouped together in the FRI Classification: Fracture (F), Related patient factors (R) and Impairment of soft tissues (I). Each element was divided into five levels of complexity. Fractures can be healed (F1) or unhealed (F2–5). Patients may be fully healthy (R1) or have 4 levels of compromise, with and without end-organ damage (R2–5). Soft tissue condition ranges from well vascularized and easily closed (I1) to major skin defects requiring free flaps (I4). In all three elements, the fifth level (F5, R5 or I5) describes a patient who has an unreconstructible bone, soft tissue envelope or is not fit for surgery. Conclusion: The FRI classification, which is based on the three major elements Fracture (F), Related patient factors (R) and Impairment of soft tissues (I) is intended to guide decision-making and improve the quality of scientific reporting for FRIs in the future. The proposed classification is based on expert opinion and therefore an essential next step is clinical validation, in order to realize the ultimate goal of improving outcomes in the management of FRI.
KW - Classification
KW - Co-morbidity
KW - Fracture
KW - Fracture-related infection
KW - FRI
KW - Infection
KW - Soft-tissue
UR - http://www.scopus.com/inward/record.url?scp=85203445893&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2024.111831
DO - 10.1016/j.injury.2024.111831
M3 - Article
C2 - 39259992
AN - SCOPUS:85203445893
SN - 0020-1383
VL - 55
JO - Injury
JF - Injury
IS - 11
M1 - 111831
ER -