The case demonstrates the importance of having well-established hospital algorithms for fracture related infection (FRI)/periprosthetic
joint infection (PJI) treatment and strictly following them at each step. In most severe cases related to multidrug-resistant (MDR) bacteria, a multiple-stage protocol is indicated, and intra-articular infusions of antibiotics should be considered in addition to standard intravenous regimens.

An infected bone fracture can lead to long-lasting problems with movement, daily function, and mental well-being. A review of 15 studies found that physical recovery often stayed below normal even after 1 year or more. Overall mental quality of life seemed stable, but other tests showed signs of ongoing depression. The evidence was mixed and limited, therefore better long-term studies and regular psychological screening are needed.

Serious bone infections can stop broken bones from healing and may lead to limb loss. We studied 22 people treated with a transplant of living bone from another part of the body to save the affected limb. Almost three-quarters achieved bone healing and infection control, although recovery often took many months, and a few patients still required amputation. Some patients required an additional bone graft. Long-term follow-up is essential when evaluating this treatment.

Surgical debridement with implant retention (DAIR) fails in up to 55 % of prosthetic joint infections. In 224 patients, the Kidney, Liver, Index surgery, Cemented prosthesis and C-reactive protein (KLIC) score showed no discrimination of DAIR failure versus a new model (areas under the curve 0.53 vs 0.85), including comorbidity, C-reactive protein, revision prosthesis, time to surgery, and Gram-negative/polymicrobial infection. Three failure-risk groups were identified: 25.5 %, 45.6 %, and 87.9 %.

Deep infections after spinal surgery are serious complications requiring surgery and prolonged antibiotic therapy. In this study, we analysed 161 patients with deep surgical-site infections after spinal instrumentation to identify factors associated with treatment failure. Gram-negative infections seemed linked to worse outcomes, whereas quinolone use appeared to be associated with better results. Treatment duration (8 vs. 12 weeks) had no significant impact.

We studied patients treated surgically for acute infection around hip or knee joint replacements to see whether a simple blood-based score reflecting nutrition and immune status could help to predict outcomes. Patients with a high score had a greater risk of treatment failure and death during follow-up. These findings suggest that routine blood tests may help to identify vulnerable patients before surgery and support better risk assessment and clinical decision-making.

Diabetic-foot bone infection is difficult to diagnose, and machine learning may help clinicians use clinical information and medical images. We reviewed studies that developed or evaluated these models for diabetic-foot osteomyelitis. Most focused on diagnosis using either clinical and laboratory information or imaging. No study combined these sources, and testing in new groups was uncommon. Future research should combine clinical information with imaging and test models in other groups.

Infected periprosthetic fractures are severe complications in orthopedic surgery with difficult management and high failure rates. This review of 32 studies (273 patients) found limited diagnostic reliability, frequent use of staged revision surgery, and high rates of recurrent infection (21 %) and revision surgeries. Current evidence is sparse and inconsistent, highlighting the need for standardized diagnostics and larger-prospective studies.

Sinus tracts are currently classified as present or absent in PJI definitions. Although appropriate for diagnosis, this binary approach does not reflect the considerable heterogeneity encountered in clinical practice. This Viewpoint highlights characteristics that may determine sinus tract complexity and proposes a framework for future standardized characterization to better inform surgical decision-making and treatment outcomes.