The pioneering FROST (Fracture-Related Outcome Study for operatively treated Tibia shaft fractures) registry, launched in 2018 by the AO Technical Commission's Anti-Infection Global Expert Committee (AIGEC), is well underway.

Developed as part of the AIGEC’s mission to improve the prevention and treatment of fracture-related infection, the FROST registry is a global, multicenter study which looks at epidemiology and treatment concepts for tibial shaft fractures. The knowledge and evidence generated by the registry offer a unique opportunity to document treatment and outcome data around tibial shaft fractures and to build a database in a systematic way. The creation of such a database allows for extensive data mining to generate hypotheses for further studies and to gather information to assist the clinical decision-making process, for example by identifying risk factors and their relationship with the outcome and complications.

Many centers worldwide expressed their interest and motivation to include patients. However, for organizational and budget reasons, it was not feasible to include all sites. To date, over 1000 patients have been enrolled in the study at 17 hospitals and clinics across 8 countries spanning Europe, North America, South Africa and Asia. As of February 2026, enrolment for the study has been successfully completed. Data analyses are currently in progress, and forthcoming results and subsequent publications will be available in the coming months.

Group photo of AIGEC members. From left:

FROST was developed by global experts in FRI including Michiel Verhofstad (NL), Michael Raschke (DE), Willem Metsemakers (BE), Bill Obremsky (US) and Andrej Trampuz (DE) in collaboration with AO Clinical Evidence, and is the largest ongoing, international fracture-related outcomes registry worldwide to date. Outcome data, due to be published in late 2026, will be pivotal in informing the global effort to address fracture-related infection (FRI).

As one of the most complex problems in modern orthopedic trauma surgery, FRI can— even after exemplary surgical care— severely impact patient recovery following fracture treatment. Improved clinical knowledge, underpinned by comprehensive data from the FROST registry, promises to reduce the cost of FRI treatment, lead to more effective treatment strategies, and promote better patient outcomes. Furthermore, the FROST data will be fundamental to developing more robust clinical FRI studies in future.