Articles | Volume 11, issue 1
https://doi.org/10.5194/jbji-11-53-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-11-53-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Diagnosis and management of fracture-related infections in a low-income country: a prospective study comparing current practice to international consensus guidelines
Department of Orthopedics and Trauma, Yaoundé General Hospital, Yaoundé, Cameroon
Department of Surgery and Specialties, University of Yaoundé I, Yaoundé, Cameroon
Experimental and Clinical Research Institute, Université Catholique de Louvain, Brussels, Belgium
Elizabeth K. Tissingh
Royal National Orthopedic Hospital NHS TRUST, London, UK
King's Global Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
Cilia Ngang
Department of Surgery and Specialties, University of Yaoundé I, Yaoundé, Cameroon
Olivier Kennedy Muluem
Department of Orthopedics and Trauma, Yaoundé General Hospital, Yaoundé, Cameroon
Department of Surgery and Specialties, University of Yaoundé I, Yaoundé, Cameroon
Jasmine Sibatcheu Simo
Department of Surgery and Specialties, University of Yaoundé I, Yaoundé, Cameroon
Richard Douvamai
Department of Surgery and Specialties, University of Yaoundé I, Yaoundé, Cameroon
Jean Bahebeck
Department of Surgery and Specialties, University of Yaoundé I, Yaoundé, Cameroon
Olivier Cornu
Experimental and Clinical Research Institute, Université Catholique de Louvain, Brussels, Belgium
Department of Orthopedics and Trauma, Cliniques Universitaires Saint-Luc, Brussels, Belgium
Martin McNally
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
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Liselot Vandenbergen, Diego Castanares Zapatero, Sébastien Briol, Alexia Verroken, Leila Belkhir, Olivier Cornu, and Jean Cyr Yombi
J. Bone Joint Infect., 11, 5–13, https://doi.org/10.5194/jbji-11-5-2026, https://doi.org/10.5194/jbji-11-5-2026, 2026
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Staphylococcus aureus bloodstream infection can cause serious complications such as bone and joint involvement. We reviewed 489 cases (2017–2022) at a Brussels tertiary hospital to identify risk factors. Prolonged bacteremia and community acquisition increased the risk, while active cancer and intensive-care stay reduced it. This study highlights the burden of bone and joint infections in Staphylococcus aureus bloodstream infection.
Josefine Slater, Maiken Stilling, Andreas Engel Krag, Sara Kousgaard Tøstesen, Mads Kristian Duborg Mikkelsen, Martin McNally, Alexander James Ramsden, Louise Kruse Jensen, Birgitte Jul Kiil, and Mats Bue
J. Bone Joint Infect., 10, 597–607, https://doi.org/10.5194/jbji-10-597-2025, https://doi.org/10.5194/jbji-10-597-2025, 2025
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We developed a pig model to study how different tissue flaps support the healing microenvironment of lower-leg composite defects. By measuring tissue metabolism and examining tissue samples under the microscope, we found distinct early responses between muscle and fascia-based flaps. This model may help researchers and clinicians better understand the healing of complex bone and soft-tissue defects and may provide a platform for evaluating clinically relevant ortho-plastic outcomes.
Antonio Loro, Fulvio Franceschi, Muhumuza M. Fisha, Emmanuel Ewochu, Geoffrey Mwanje, Annamaria Dal Lago, and Martin McNally
J. Bone Joint Infect., 10, 155–163, https://doi.org/10.5194/jbji-10-155-2025, https://doi.org/10.5194/jbji-10-155-2025, 2025
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This retrospective study shows that autogenous non-vascularized bone graft is a viable option for managing post-osteomyelitis bone defects in children in low-resource settings. Bone union was achieved in all cases at the last follow-up (minimum of 7 years). Recurrence of infection was seen in two cases. Studies into this specific technique are important as it does not require super-specialized centres or skills, both of which are scarce in low-resource settings.
Asanka Wijendra, Alex Ramsden, and Martin McNally
J. Bone Joint Infect., 8, 183–188, https://doi.org/10.5194/jbji-8-183-2023, https://doi.org/10.5194/jbji-8-183-2023, 2023
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Cancerous transformation is a rare but potentially life-threatening complication of chronic bone infection. As with all forms of cancer, early detection and diagnosis is crucial to outcome.
Whilst there have been over 100 cases of chronic bone infection with cancerous transformation reported in the literature between 1999 and 2020, this is the first case report to document transformation with 20 years of concordant imaging and clinical review.
Niels Vanvelk, Esther M. M. Van Lieshout, Jolien Onsea, Jonathan Sliepen, Geertje Govaert, Frank F. A. IJpma, Melissa Depypere, Jamie Ferguson, Martin McNally, William T. Obremskey, Charalampos Zalavras, Michael H. J. Verhofstad, and Willem-Jan Metsemakers
J. Bone Joint Infect., 8, 133–142, https://doi.org/10.5194/jbji-8-133-2023, https://doi.org/10.5194/jbji-8-133-2023, 2023
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This international retrospective cohort study displays the diagnostic characteristics of 609 patients who were treated for fracture-related infection (FRI). Clinical confirmatory criteria were present in 77% of patients. In the remaining patients, the decision to operatively collect deep tissue cultures had to be based on a set of suggestive criteria. The combined use of these suggestive criteria should guide treating physicians in the management pathway of FRI.
Maria Dudareva, Andrew Hotchen, Martin A. McNally, Jamie Hartmann-Boyce, Matthew Scarborough, and Gary Collins
J. Bone Joint Infect., 6, 257–271, https://doi.org/10.5194/jbji-6-257-2021, https://doi.org/10.5194/jbji-6-257-2021, 2021
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Clinical prognostic models are tools that predict treatment outcomes for individual patients. For adults with bone and joint infection treated with surgery and implant removal, this review found no existing unbiased clinical prediction models that took modifiable health factors into account to estimate prognosis. Developing a clinical prognostic model may help treatment decisions and future targeted research in orthopaedic infection.
Martin McNally
J. Bone Joint Infect., 6, 199–201, https://doi.org/10.5194/jbji-6-199-2021, https://doi.org/10.5194/jbji-6-199-2021, 2021
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This paper provides further evidence that treatment of osteomyelitis by serial debridement without the use of local antimicrobials has high recurrence rates (20 %–30 %). The addition of bioglass did not improve this compared to using bone graft alone. Additional systemic antibiotic was required in many cases, increasing the risk of antimicrobial resistance. Recent series of single-stage surgery with local antibiotic delivery have reported better outcomes.
Jamie Ferguson, Myriam Alexander, Stuart Bruce, Matthew O'Connell, Sue Beecroft, and Martin McNally
J. Bone Joint Infect., 6, 151–163, https://doi.org/10.5194/jbji-6-151-2021, https://doi.org/10.5194/jbji-6-151-2021, 2021
Martina Galea Wismayer, Kurstein Sant, Ryan Giordmaina, and Martin McNally
J. Bone Joint Infect., 6, 141–145, https://doi.org/10.5194/jbji-6-141-2021, https://doi.org/10.5194/jbji-6-141-2021, 2021
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We report the treatment of bone infection in a patient with a rare disease which causes overgrowth of the limb. Careful assessment of the scans showed that the infection was in some new bone which had formed in the soft tissues after a minor injury to the leg and not in one of the major bones. This made treatment much easier with a successful outcome.
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Short summary
This study assessed whether the diagnosis and management of fracture-related infections (FRIs) in a low- and middle-income countries (LMICs) currently align with consensus guidelines. We found that two-thirds of cases are managed outside the international guidelines. While the consensus definition is applicable, diagnostic capacity remains limited and microbiological standards are often impractical. Our findings highlight the need to adapt guidelines to local realities and to strengthen capacity in LMICs.
This study assessed whether the diagnosis and management of fracture-related infections (FRIs)...