title: Infection reduces return-to-duty rates for soldiers with Type III open tibia fractures.
abstract: BACKGROUND
  Infection is a potentially devastating complication following severe lower extremity trauma, but its impact on the outcomes of combat casualties remains unclear. We hypothesize that orthopedic infectious complications will have a negative impact on holistic patient outcome as measured by return-to-duty (RTD) and disability ratings among wounded soldiers.
  
  
  METHODS
  We reviewed the medical records for 115 wounded soldiers who sustained a Type III open tibia fracture and tabulated the prevalence of infectious complications. We searched the Physical Evaluation Board database to determine the disability ratings of soldiers with and without an infection and how many of each group was able to return to active duty service. The average percent disability rating and RTD rates between groups were compared using an unpaired t test and χ test, respectively.
  
  
  RESULTS
  Overall, 40% of our cohort had an infectious complication of their fractured limb. Twenty-one soldiers were able to RTD, while 94 could not and were medically retired. Of those medically retired, 44% had an infection. The average percent disability among soldiers with infection was 55%, compared with 47% for those who were not infected (p = 0.1407). Soldiers who experienced any type of infectious complication (p = 0.0470) and having osteomyelitis (p = 0.0335) had a lower chance of RTD compared with those who had no infection. Having a deep soft tissue infection alone showed a strong trend toward decreased RTD rate (p = 0.0558).
  
  
  CONCLUSIONS
  Infectious complications following severe lower extremity trauma significantly decrease the rate of RTD. In addition, the presence of infectious complications demonstrates a trend toward higher disability ratings in the combat wounded.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: From the Department of Orthopaedics and Rehabilitation (M.A.N., J.C.R., T.C.B.), and Infectious Disease Service (C.K.M.), Department of Medicine, San Antonio Military Medical Center; and US Army Institute of Surgical Research (J.C.W.), Fort Sam Houston, San Antonio, Texas; and Orthopaedic Surgery Service (J.R.H.), Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Napierala
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Rivera
authors.forename: Travis C
authors.initials: TC
authors.lastname: Burns
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
mesh_terms: D000328:Adult; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D005597:Fractures, Open / Q000150:complications*; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications*; D014481:United States / Q000453:epidemiology; D014946:Wound Infection / Q000453:epidemiology / Q000209:etiology*