Scoping Review: Nutritional Deficiencies in Fracture-Related Infection and Osteomyelitis

Bone infection, encompassing fracture-related infection (FRI) and chronic osteomyelitis (COM), remains a significant challenge in orthopaedic practice due to its high morbidity, prolonged treatment pathways, and substantial healthcare costs. Both conditions involve complex pathophysiological processes characterized by biofilm formation, chronic inflammation, and impaired bone healing. Host-related factors—particularly nutritional status—play a pivotal role in determining infection risk, treatment response, and functional recovery. Despite growing recognition of the importance of nutrition in surgical and trauma outcomes, there is limited evidence specifically addressing nutritional deficiencies in the context of bone infection. This scoping review aims to systematically map the existing literature on nutritional deficiencies associated with bone infection, including FRI and COM. The objectives are to identify which macro- and micronutrient deficiencies have been reported in affected patients, summarize the diagnostic methods used to assess nutritional status, explore associations between deficiencies and clinical outcomes, and identify any interventional studies on nutritional supplementation. The review will also highlight evidence gaps to inform future research and clinical strategies aimed at optimizing host status in bone infection management. The review will be conducted according to the Joanna Briggs Institute (JBI) framework for scoping reviews and reported following the PRISMA-ScR guidelines. Eligible studies will include human participants of any age with FRI, COM, or postoperative bone infection, published in English between 2005 and 2025. Observational and interventional designs will be included, while animal, in vitro, and single case reports will be excluded. Searches will be performed across MEDLINE (via PubMed), Scopus, Web of Science, and the Cochrane Library, supplemented by grey literature sources such as conference proceedings and organizational guidelines. Two reviewers will independently screen, extract, and appraise data, with discrepancies resolved by consensus or a third reviewer. Critical appraisal will employ appropriate tools (MINORS, CASP), and evidence quality will be graded using GRADE. Data will be synthesized descriptively and presented through tables and evidence maps. By comprehensively summarizing the state of knowledge on nutritional deficiencies in bone infection, this review will contribute to a more nuanced understanding of host optimization in orthopaedic infection management. The findings are expected to guide future clinical research, promote the integration of nutritional assessment into infection care pathways, and support the development of targeted nutritional interventions to improve patient outcomes.