title: The relationship between time to surgical debridement and incidence of infection in grade III open fractures.
abstract: OBJECTIVE
  The purpose of this study was to determine the association between time to initial debridement and infection rate in high-energy (grade III) open fractures of tibia.
  
  
  METHODS
  All patients presenting with open fractures were included in the study. The inclusion criteria were Gustilo III A, B and C open fractures of tibia. Time of injury, time of arrival to the hospital, time of initial debridement and subsequent soft tissue procedures were recorded. The primary outcome measure was a diagnosis of infection or osteomyelitis at 1 year. Secondary outcome measure was fracture union at 1 year.
  
  
  RESULTS
  Sixty-seven (67) patients with grade III open fractures were included; the mean age was 32.4 years (54 males and 13 females). Eight patients (12 %) in this study went on to develop a deep infection, and there were 6 (8.4 %) non-unions. The infection rate for patients in the group who underwent debridement in less than 6 h and those greater than 6 h was 13.1 and 10.8 %, respectively. No statistically significant difference could be demonstrated between the two groups (p = 0.56). While there was no significant relationship between grade of fracture and infection rate (p = 0.07), the relationship between grade of fracture and non-union was significant (p = 0.02).
  
  
  CONCLUSIONS
  Our study shows that the risk of developing an infection was not increased if the primary surgical management was delayed more than 6 h after injury. Therefore, reasonable delays in surgical treatment for patients with open fractures may be justified in order to provide an optimal operating environment.
authors.affiliation: Trauma and Orthopaedics, Hospital Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK, drjagwant@gmail.com.
authors.forename: Jagwant
authors.initials: J
authors.lastname: Singh
authors.forename: Rohit
authors.initials: R
authors.lastname: Rambani
authors.forename: Zaid
authors.initials: Z
authors.lastname: Hashim
authors.forename: Raghu
authors.initials: R
authors.lastname: Raman
authors.forename: Hemant Kumar
authors.initials: HK
authors.lastname: Sharma