PATIENT SELECTION FOR SINGLE STAGE RECONSTRUCTION IN LONG BONE FRACTURE RELATED INFECTION

Abstract

Background: Both single-stage and staged reconstruction are used in cases of infection associated with a non-healed long-bone fracture. The available results are hard to interpret since the type of treatment given depends on the complexity of the defect, the patient's condition, the requirements of the soft tissues, the microbial details, and the local expertise. A systematic review published in 2025 looked at the overall outcomes but did not identify the patient characteristics that should guide the choice of stage. The aim is to identify and critically evaluate the factors that are given as reasons for choosing single-stage or staged reconstruction in adults who have a infection associated with a long bone fracture, and to determine whether any of these factors is linked to different treatment outcomes.
Methods: The databases MEDLINE, Embase, Scopus, Web of Science Core Collection and CENTRAL will be searched from their inception up to the final date of the search. In addition, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and the reference lists of the included reports and relevant reviews will be examined. Two reviewers will independently carry out the screening of the records, the extraction of data and the assessment of risk of bias.  Comparative non-randomized studies will be evaluated using ROBINS-I while uncontrolled case series will be assessed with the Joanna Briggs Institute case-series checklist. The selection criteria will be grouped by clinical domain. A meta-analysis will only be performed when the populations, interventions and definitions of the outcomes are sufficiently similar; in all other cases, a synthesis without meta-analysis will be provided using structured tables that show effect direction and study characteristics.
Discussion: This review looks at three questions which are frequently mixed up—whether a reconstruction is technically possible, whether a particular feature indicates a poor outcome, and whether that feature affects the relative advantages of single-stage as compared with staged treatment—the aim being to assist in open, multidisciplinary decision-making and in the planning of prospective comparative studies. staged treatment—the aim being to assist in open, multidisciplinary decision-making and in the planning of prospective comparative studies. For registration and reporting: the protocol will be registered prospectively in PROSPERO and will be reported in accordance with PRISMA-P; the completed review will comply with PRISMA 2020 and SWiM in the case where a metaanalysis is not appropriate.