Can a fracture cause fever?

Can a Fracture Cause Fever?

Yes, a fracture can cause fever, particularly in cases of fracture-related infection (FRI) which occurs in approximately 1-2% of closed fractures and up to 30% of open fractures. 1

Pathophysiology of Fever After Fracture

• Fever following a fracture may be due to several mechanisms:

  • Inflammatory response to tissue injury and bone trauma 1
  • Fracture-related infection (FRI), which is more common in open fractures (6-44%) than closed fractures (1-2%) 1
  • Hematoma formation and subsequent inflammatory response 1

• The timing of fever is important for differential diagnosis:

  • Fever within the first 48 hours after fracture is rarely due to infection and more commonly related to the inflammatory response to trauma 1
  • Fever after postoperative day 2 is more concerning for infectious complications 2
  • Multiple fever spikes are more likely to indicate infection than a single temperature elevation 2

Diagnostic Considerations

• Confirmatory criteria for fracture-related infection include:

  • Presence of a sinus tract communicating with the bone or implant 3
  • Wound breakdown exposing bone or implant 3
  • Purulent drainage around the fracture site 3
  • Phenotypically indistinguishable pathogens identified from at least 2 separate deep tissue specimens 3

• Suggestive criteria for fracture-related infection include:

  • Local signs: pain, redness, swelling at fracture site 3
  • Systemic signs: fever, chills 3
  • Laboratory findings: elevated inflammatory markers (ESR, CRP) 3
  • Radiological signs: implant loosening, bone lysis, periosteal bone formation 3

• Important to note that 23% of fracture-related infections present without obvious clinical confirmatory criteria, making diagnosis challenging 4

Management Implications

• For open fractures, antibiotic prophylaxis should be administered as soon as possible and continued for a maximum of 48-72 hours to prevent infection 1

  • First-line options include amoxicillin-clavulanate or cephalosporins 1
  • For beta-lactam allergies, clindamycin plus gentamicin is recommended 1

• Additional infection prevention measures include:

  • Thorough wound cleaning and irrigation 1
  • Sterile dressing of wounds 1
  • Fracture immobilization 1
  • Appropriate surgical debridement and fracture stabilization 1

• For suspected fracture-related infection:

  • Open the wound, evacuate infected material, and continue dressing changes 1
  • Obtain appropriate cultures before starting antibiotics 1
  • Consider imaging studies to assess extent of infection 1

Special Considerations

• Risk factors for infection after open fractures include:

  • Exposure time greater than 24 hours 5
  • Gustilo type III fractures (especially IIIB) 5
  • Tscherne type II and III fractures 5

• Fever workup in elderly patients with fractures:

  • Routine fever workup is not warranted for all postoperative fevers 2
  • For fever after postoperative day 2 or multiple fever spikes, chest x-ray and urinalysis are recommended to rule out pneumonia and urinary tract infection 2

• Osteomyelitis should be considered in cases of prolonged unexplained fever, even in adults 6

• Always consider non-infectious causes of fever after fracture, including:

  • Pulmonary embolism 2
  • Drug reactions 1
  • Fat embolism syndrome in long bone fractures 1

• Remember that a fracture may be a red herring - other causes of fever should be considered, especially in patients with recent travel to endemic areas for infectious diseases 7