title: Open fractures of the distal radius: the effects of delayed debridement and immediate internal fixation on infection rates and the need for secondary procedures.
abstract: OBJECTIVE
  There are few clinical data evaluating the outcome of surgery for open distal radius fractures based on treatment method. Specifically, the major contributing factors to infection are largely unknown. The purpose of this study is to determine the effect of early versus delayed debridement and the choice of initial external versus internal fixation on infection rates and the need for secondary procedures.
  
  
  METHODS
  Thirty-two patients with open distal radius fractures were identified from a database. Ten debridements were early (<6 h after hospital admission), and 22 debridements were delayed (>6 h after hospital admission). There were 10 treating surgeons for the 32 patients in this study. Based on the attending surgeon's preference and experience, 20 fractures were treated with external fixation, 7 with plating, and 5 with planned staged conversion from external fixation to plating. The cohort included 19 grade I, 11 grade II, and 3 grade IIIA open injuries.
  
  
  RESULTS
  There were no infections, regardless of the time to debridement or the use of immediate plating. Other complications requiring secondary procedures occurred more frequently in patients treated with a planned staged conversion from external fixation to plating than in the patients treated with either external fixation or plating.
  
  
  CONCLUSIONS
  We did not encounter infections for grade I and grade II open distal radius fractures, and infections do not appear to be related to either the time to debridement or the initial type of fracture fixation. Plating might be safe at the initial debridement, but temporary external fixation with a staged conversion to plating increases the risk of complications, which necessitates corrective secondary procedures.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA 02118, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Kurylo
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Axelrad
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Andrew
authors.initials: A
authors.lastname: Jawa
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016208:Databases, Factual; D003646:Debridement / Q000379:methods*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents