Host classification predicts infection after open fracture.
We propose that the classification commonly used in patients with osteomyelitis, the Gustilo classification, also is applicable to patients with open fractures as a method of identifying increased risk of infection because of comorbid medical illness. The records of 174 adult patients sustaining open fractures of long bones were retrospectively reviewed. Each patient was sorted into Class A, B, or C based on 14 immune system compromising factors. Class A has no compromising factors, Class B has one or two compromising factors, and Class C has more than three compromising factors. The association between class and infection was examined. The incidence of infection was 4%, 15%, and 30% in patients in Classes A, B, and C, respectively. Patients in Class B were 2.86 times more likely to have an infection, and patients in Class C were 5.72 times more likely to have an infection when both groups of patients were compared with patients in Class A. The Gustilo classification, location of fracture, and tobacco use are all factors associated with infection. Patients in Class B or C are at markedly increased risk of infection and may benefit from additional or alternative therapies that decrease the risk of infection.


METHODS
Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
Bowen
Thomas R
TR
Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA 17822, USA.
Widmaier
James C
JC
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006304:Health Status; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013530:Surgical Wound Infection / Q000145:classification* / Q000453:epidemiology; D014193:Trauma Centers