Outcomes in open tibia fractures: relationship between delay in treatment and infection.
BACKGROUND
Emergent irrigation and debridement has been accepted as a mainstay of open fracture treatment. The purpose of this study was to evaluate the infectious outcome of open tibia fractures relative to the time from injury to operative irrigation and debridement.


METHODS
One hundred seventy-eight patients with 191 consecutive fractures were retrospectively reviewed. Of these, 103 patients with 106 fractures were available for this study, with an average follow-up of 10.23 months.


RESULTS
Results revealed 21.7% type I fractures, 43.4% type II fractures, 16.0% type IIIa fractures, 11.3% type IIIb fractures, and 7.5% type IIIc fractures. Of all fracture types, 22.6% became infected and 5.7% went on to have osteomyelitis. The average time to treatment was not significantly different in infected versus noninfected fractures across fracture types. No infection occurred when the time to surgery was within 2 hours; however, no significant increase in infection was discovered with respect to patients treated after 6 hours compared with those treated within 6 hours.


CONCLUSIONS
The results support the Gustilo grading system of open fractures as a significant prognostic indicator for infectious complication. We continue to support the emergent treatment of open tibia fractures.
Khatod
Monti
M
Department of Orthopaedics, Division of Traumatology, School of Medicine, University of California-San Diego, La Jolla, CA, USA. mkhato@caregroup.harvard.edu
Botte
Michael J
MJ
Hoyt
David B
DB
Meyer
R Scott
RS
Smith
Jeffrey M
JM
Akeson
Wayne H
WH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003646:Debridement; D005260:Female; D005597:Fractures, Open / Q000145:classification* / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology; D013978:Tibial Fractures / Q000145:classification* / Q000150:complications / Q000601:surgery; D013997:Time Factors