DOI: 10.1097/os9.0000000000000017 ISSN: 2666-769X

“Orthoplastic” Collaboration in fracture-related infection management reflects case complexity and is associated with achievable infection control

Natalie Vu, Nina Fisher, Abhishek Ganta, Sanjit Konda, Pierre Saadeh, Kenneth Egol
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Background:

The purpose of this study was to characterize fracture-related infection (FRI) cases requiring plastic surgery involvement and to evaluate infection-related outcomes in the setting of “orthoplastic collaboration.”

Methods:

A retrospective review was conducted of all patients treated for FRI between 2018 and 2024. Patients were stratified by whether plastic surgery was involved in treatment. Plastic surgery involvement was defined as participation by a board-certified plastic surgeon in procedures requiring soft-tissue reconstruction. Baseline demographics, comorbidities, infection characteristics, and treatment variables were compared. Primary outcomes were FRI resolution and time to infection resolution. Secondary outcomes included time-to-fracture healing, number of reoperations, and readmissions. Multivariable analyses were performed to adjust for baseline differences between cohorts.

Results:

Of 385 patients treated for FRI, 47 (12.2%) required plastic surgery involvement. Demographics were comparable between groups. Patients requiring plastic surgery demonstrated increased case complexity, with a greater proportion of confirmed FRIs (93.62% vs 76.04%, P = 0.002) and higher rates of soft-tissue reconstruction, including flap coverage (29.8% vs 0.89%, P < 0.001) and split-thickness skin grafting (21.28% vs 10.6%, P = 0.035). These patients also had longer time to infection resolution (387.34 vs 202.94 days, P = 0.004), longer fracture-healing time (334.85 vs 204.76 days, P = 0.020), and more irrigation and debridement procedures (2.98 vs 1.64, P = 0.003). Despite increased complexity, patients requiring plastic surgery involvement achieved high rates of infection resolution (93.62% vs 81.36%, P = 0.037). On multivariable analysis adjusting for baseline differences, plastic surgery involvement remained independently associated with higher odds of infection resolution [odds ratio (OR), 3.826; 95% confidence interval (CI), 1.130–12.959; P = 0.031] and fewer readmissions ( β  = − 0.804; 95% CI, −1.558 to −0.051; P = 0.037).

Conclusion:

Plastic surgery involvement in FRI management was associated with greater infection severity and soft-tissue compromise. Despite increased case complexity and prolonged fracture healing, orthoplastic collaboration was associated with better infection control and fewer readmissions, supporting a multidisciplinary approach to complex FRI cases.

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