title: Microbiology and injury characteristics in severe open tibia fractures from combat.
abstract: BACKGROUND
  Type III open tibia fractures are common combat injuries. The purpose of the study was to evaluate the effect of injury characteristics and surveillance cultures on outcomes in combat-related severe open tibia fractures.
  
  
  METHODS
  We conducted a retrospective study of all combat-related open Gustilo and Anderson (G/A) type III diaphyseal tibia fractures treated at our centers between March 2003 and September 2007.
  
  
  RESULTS
  One hundred ninety-two Operation Iraqi Freedom/Operation Enduring Freedom military personnel with 213 type III open tibial shaft fractures were identified. Fifty-seven extremities (27%) developed a deep infection and 47 extremities (22%) ultimately underwent amputation at an average follow-up of 24 months. Orthopedic Trauma Association type C fractures took significantly longer to achieve osseous union (p = 0.02). G/A type III B and III C fractures were more likely to undergo an amputation and took longer to achieve fracture union. Deep infection and osteomyelitis were significantly associated with amputation, revision operation, and prolonged time to union. Surveillance cultures were positive in 64% of extremities and 93% of these cultures isolated gram-negative species. In contrast, infecting organisms were predominantly gram-positive.
  
  
  CONCLUSIONS
  Type III open tibia fractures from combat unite in 80.3% of cases at an average of 9.2 months. We recorded a 27% deep infection rate and a 22% amputation rate. The G/A type is associated with development of deep infection, need for amputation, and time to union. Positive surveillance cultures are associated with development of deep infection, osteomyelitis, and ultimate need for amputation. Surveillance cultures were not predictive of the infecting organism if a deep infection subsequently develops.
authors.affiliation: Department of Orthopedics and Rehabilitation, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, TX 78234, USA. travis.burns@amedd.army.mil
authors.forename: Travis C
authors.initials: TC
authors.lastname: Burns
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Stinner
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Mack
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
authors.forename: Rob
authors.initials: R
authors.lastname: Beer
authors.forename: Tobin T
authors.initials: TT
authors.lastname: Eckel
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Possley
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beltran
authors.forename: Roman A
authors.initials: RA
authors.lastname: Hayda
authors.forename: Romney C
authors.initials: RC
authors.lastname: Andersen
authors.forename: John J
authors.initials: JJ
authors.lastname: Keeling
authors.forename: Harold M
authors.initials: HM
authors.lastname: Frisch
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
authors.forename: James R
authors.initials: JR
authors.lastname: Ficke
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical; D017102:Fracture Healing; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000209:etiology / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D014946:Wound Infection / Q000209:etiology / Q000382:microbiology / Q000473:pathology*; D055815:Young Adult