title: Is time to flap coverage of open tibial fractures an independent predictor of flap-related complications?
abstract: OBJECTIVE
  The importance of the timing of flap coverage of open tibial shaft fractures remains controversial. Many studies have shown increased complications and infection rates associated with delay in coverage but have not controlled for risk factors that might be associated with both delay in coverage and complications. We hypothesized that the timing of flap coverage of open tibial fractures is not predictive of complications after controlling for known risk factors.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Sixty-nine patients treated for acute tibial fractures (45 tibial shaft, 17 plateau, and 12 pilon fractures) at our center from 2004 through 2009 required 74 flaps. Patients requiring flaps later for wound breakdown or infection were excluded.
  
  
  METHODS
  Electronic records and prospective trauma database were reviewed. All fractures were AO classified by a trauma fellowship-trained orthopaedic surgeon.
  
  
  METHODS
  Primary outcome was flap complication, defined as infection or other flap-related adverse outcome requiring surgical treatment. Logistic regression analysis was conducted.
  
  
  RESULTS
  A logistic regression model that separated the first 7 days after injury from subsequent days found no increased risk for days 1 through 7. The odds of complications, and of infection in particular, increased by 11% and 16%, respectively, for each day beyond day 7 (P < 0.04).
  
  
  CONCLUSIONS
  Even after controlling for known risk factors for complications, including injury severity, time to flap coverage was a significant predictor of complications.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and †Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Jean-Claude G
authors.initials: JC
authors.lastname: D'Alleyrand
authors.forename: Theodore T
authors.initials: TT
authors.lastname: Manson
authors.forename: Lindsay
authors.initials: L
authors.lastname: Dancy
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
authors.forename: J Bradford H
authors.initials: JB
authors.lastname: Bertumen
authors.forename: Thomas
authors.initials: T
authors.lastname: Meskey
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects* / Q000473:pathology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult