{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:45:21Z","timestamp":1792014321252,"version":"4.4.0"},"reference-count":18,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Aim: Periprosthetic fracture-related infections (PFRIs) are a serious complication of total arthroplasty, with incidence rates increasing in line with the growing number of joint replacements. PFRI can lead to prolonged hospitalization, multiple surgical procedures and suboptimal functional outcomes. The diagnosis of PFRI remains challenging due to the overlap of clinical symptoms with other post-traumatic conditions, and identification of the pathogen often fails through conventional methods. This study also highlights the importance of a personalized medicine approach in managing PFRI, where diagnostic and therapeutic decisions are tailored to the individual patient\u2019s comorbidities, immune status and bone healing capacity. By integrating clinical, microbiological and imaging data, our findings support precision-based strategies to optimize outcomes and minimize complication. Methods: This retrospective case series was conducted at the Unit of Osteoarticular Infection of the University of Turin, Italy, from January 2018 to December 2023. Patients who developed septic complications after open reduction and internal fixation (ORIF) of periprosthetic fractures involving hip or knee implants were included. The infection was diagnosed in accordance with established guidelines, and treatment decisions were based on clinical, microbiological and radiological findings. Results: In the present study, periprosthetic fractures complicated by infections were identified in nine patients (5.4%), constituting a small but significant subset of cases. The cases were then categorized into four clinical scenarios based on the following variables: joint involvement, fracture healing and infection progression. Scenario A, involving fractures without prosthetic involvement and unhealed fractures, included three patients (33%) and was treated with debridement and change of the fixation device. Scenario B, involving fractures without prosthetic involvement but with healed fractures, involved one patient (11%), where the ongoing infection was confirmed despite the healed fracture and where the device could be removed. The third scenario (C), which pertains to cases involving prosthetic involvement, included three patients (33%) who required replacement or removal of the prosthesis and, in some cases, a second stage. The fourth scenario, involving patients with limited operability, included two patients (22%) for whom no surgery was performed. Despite the significant clinical challenges encountered, the paucity of literature on the management of periprosthetic fractures with septic complications is limited, highlighting the need for further research in this understudied area. Conclusions: PFRI remains a challenging complication that necessitates a multidisciplinary approach to diagnosis and treatment. Despite advances in imaging and microbiological testing, the early detection and identification of pathogens remain challenging, emphasizing the necessity for enhanced diagnostic methods. This study offers valuable insights into the management of PFRI and provides a foundation for future research to develop optimal diagnostic and therapeutic strategies.<\/jats:p>","DOI":"10.3390\/jpm15120576","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T11:19:51Z","timestamp":1764328791000},"page":"576","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Personalized Approaches to Diagnostic and Therapeutic Strategies in Periprosthetic Fracture-Related Infections (PFRIs): Case Series and Literature Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9927-8181","authenticated-orcid":false,"given":"Marianna","family":"Faggiani","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology, Trauma Center of Turin, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Zugnoni","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology (Ortopedia e Traumatologia 1U), University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Olivero","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology, Trauma Center of Turin, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Risitano","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology, Trauma Center of Turin, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Malizia","sequence":"additional","affiliation":[{"name":"Sports Science and Rehabilitation University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Scabini","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6076-8527","authenticated-orcid":false,"given":"Marcello","family":"Capella","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology, Trauma Center of Turin, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Artiaco","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology, Trauma Center of Turin, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5400-3508","authenticated-orcid":false,"given":"Simone","family":"Sanfilippo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology (Ortopedia e Traumatologia 1U), University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3999-4121","authenticated-orcid":false,"given":"Alessandro","family":"Mass\u00e8","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology, Trauma Center of Turin, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5792\/ksrr.2015.27.1.1","article-title":"Periprosthetic Fractures Following Total Knee Arthroplasty","volume":"27","author":"Yoo","year":"2015","journal-title":"Knee Surg. Relat. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/BOT.0000000000001614","article-title":"Diagnosing fracture-related infection: Current concepts and recommendations","volume":"34","author":"Govaert","year":"2020","journal-title":"J. Orthop. Trauma"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1302\/2058-5241.4.180093","article-title":"Infection after fracture fixation. EFORT Open Reviews","volume":"4","author":"Steinmetz","year":"2019","journal-title":"EFORT Open Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111898","DOI":"10.1016\/j.injury.2024.111898","article-title":"New diagnostic techniques for diagnosing facture-related infections","volume":"55","author":"Hoffmann","year":"2018","journal-title":"Injury"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: A consensus on definition from an international expert group","volume":"49","author":"Metsemakers","year":"2018","journal-title":"Injury"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"86","DOI":"10.12671\/jmt.2025.00164","article-title":"Fracture-related infections: A comprehensive review of diagnosis and prevention","volume":"38","author":"Chung","year":"2025","journal-title":"J. Musculoskelet Trauma."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jor.2023.11.050","article-title":"Fracture related Infection - Challenges in definition and diagnosis","volume":"49","author":"Rupp","year":"2024","journal-title":"J. Orthop."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Stevenson, M.C., Slater, J.C., Sagi, H.C., Palacio Bedoya, F., and Powers-Fletcher, M.V. (2022). Diagnosing Fracture-Related Infections: Where Are We Now?. J. Clin. Microbiol., 16.","DOI":"10.1128\/JCM.02807-20"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Hoveidaei, A., Tavakoli, Y., Ramezanpour, M.R., Omouri-kharashtomi, M., Taghavi, S.P., Hoveidaei, A.H., and Conway, J.D. (2025). Imaging in Periprosthetic Joint Infection Diagnosis: A Comprehensive Review. Microorganisms, 13.","DOI":"10.3390\/microorganisms13010010"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"947","DOI":"10.21037\/qims-24-403","article-title":"Medical imaging diagnosis of orthopedic prosthesis-associated infections: A narrative review","volume":"15","author":"Gu","year":"2025","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s00402-019-03287-4","article-title":"General treatment principles for fracture-related infection: Recommendations from an international expert group","volume":"140","author":"Metsemakers","year":"2020","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Matsuo, T., Thompson, A.L., and Yuan, B.J. (2025). The Latest Approaches to Fracture-Related Infection. Curr. Infect. Dis. Rep., 27.","DOI":"10.1007\/s11908-025-00864-0"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"102620","DOI":"10.1016\/j.injury.2025.112563","article-title":"Defining treatment outcome in fracture-related infections: A scoping review","volume":"56","author":"Reinert","year":"2025","journal-title":"Injury"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"McNally, M., Corrigan, R., Sliepen, J., Dudareva, M., Rentenaar, R., IJpma, F., Atkins, B.L., Wouthuyzen-Bakker , M., and Govaert, G.A.M. (2022). What Factors Affect Outcome in the Treatment of Fracture-Related Infection?. Antibiotics, 11.","DOI":"10.3390\/antibiotics11070946"},{"key":"ref_15","first-page":"293","article-title":"The Vancouver classification of periprosthetic fractures","volume":"44","author":"Duncan","year":"1995","journal-title":"Instr. Course Lect."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Rorabeck, C.H., and Taylor, J.W. (1999). Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop. Clin. N. Am., 30.","DOI":"10.1016\/S0030-5898(05)70075-4"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Felix, N.A., Stuart, M.J., and Hanssen, A.D. (1997). Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin. Orthop. Relat. Res.","DOI":"10.1097\/00003086-199712000-00016"},{"key":"ref_18","first-page":"475","article-title":"Infection after fracture fixation: Current surgical and microbiological concepts","volume":"47","author":"Metsemakers","year":"2016","journal-title":"Injury"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/12\/576\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T16:51:32Z","timestamp":1764953492000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/12\/576"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":18,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jpm15120576"],"URL":"https:\/\/doi.org\/10.3390\/jpm15120576","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]}}}