Praxis Medical Insights

Pathophysiology and Diagnostic Considerations

A fracture can cause fever, particularly in cases of fracture-related infection (FRI), which occurs in approximately 1-2% of closed fractures and up to 30% of open fractures 1
Fever following a fracture may be due to several mechanisms, including inflammatory response to tissue injury and bone trauma, fracture-related infection (FRI), and hematoma formation and subsequent inflammatory response 1, 2
The American College of Surgeons recommends considering fracture-related infection in patients with fever after a fracture, especially if the fever persists or recurs 2
Confirmatory criteria for fracture-related infection include presence of a sinus tract communicating with the bone or implant, wound breakdown exposing bone or implant, purulent drainage around the fracture site, and phenotypically indistinguishable pathogens identified from at least 2 separate deep tissue specimens, as recommended by the Infectious Diseases Society of America 4
Suggestive criteria for fracture-related infection include local signs such as pain, redness, swelling at fracture site, systemic signs such as fever, chills, laboratory findings such as elevated inflammatory markers, and radiological signs such as implant loosening, bone lysis, periosteal bone formation, as suggested by the Orthopaedic Trauma Association 4

The American College of Surgeons recommends antibiotic prophylaxis for open fractures, which should be administered as soon as possible and continued for a maximum of 48-72 hours to prevent infection 2
First-line options for antibiotic prophylaxis include amoxicillin-clavulanate or cephalosporins, and for beta-lactam allergies, clindamycin plus gentamicin is recommended, as suggested by the American Academy of Orthopaedic Surgeons 2
Additional infection prevention measures include thorough wound cleaning and irrigation, sterile dressing of wounds, fracture immobilization, and appropriate surgical debridement and fracture stabilization, as recommended by the American Heart Association 2, 5
For suspected fracture-related infection, the Infectious Diseases Society of America recommends opening the wound, evacuating infected material, and continuing dressing changes, obtaining appropriate cultures before starting antibiotics, and considering imaging studies to assess extent of infection 3, 6

Drug reactions and fat embolism syndrome in long bone fractures should be considered as non-infectious causes of fever after fracture, as recommended by the American College of Clinical Pharmacology 2, 3