title: Prospective evaluation of treatment of open fractures: effect of time to irrigation and debridement.
abstract: OBJECTIVE
  The standard practice of irrigation and debridement (I&D) of open fractures within 6 hours of injury remains controversial.
  
  
  OBJECTIVE
  To prospectively evaluate the effect of the time from injury to the initial I&D on infectious complications.
  
  
  METHODS
  A total of 315 patients who were admitted to a level 1 trauma center with open extremity fractures from September 22, 2008, through June 21, 2011, were enrolled in a prospective observational study and followed up for 1 year after discharge (mean [SD] age, 33.9 [16.3] years; 79% were male; and 78.4% were due to blunt trauma). Demographics, mechanism of injury, time to I&D, operative intervention, and incidence of local infectious complications were documented. Patients were stratified into 4 groups based on the time of I&D (<6 hours, 7-12 hours, 13-18 hours, and 19-24 hours after injury). Univariate and multivariable analysis were used to determine the effect of time to I&D on outcomes.
  
  
  METHODS
  Development of local infectious complications at early (<30 days) or late (>30 days and <1 year) intervals from admission.
  
  
  RESULTS
  The most frequently injured site was the lower extremity (70.2%), and 47.9% of all injuries were Gustilo classification type III. There was no difference in fracture location, degree of contamination, or antibiotic use between groups. All patients underwent I&D within 24 hours. Overall, 14 patients (4.4%) developed early wound infections, while 10 (3.2%) developed late wound infections (after 30 days). The infection rate was not statistically different on univariate (<6 hours, 4.7%; 7-12 hours, 7.5%; 13-18 hours, 3.1%; and 19-24 hours, 3.6%; P = .65) or multivariable analysis (<6-hour group [reference], P = .65; 7- to 12-hour group adjusted odds ratio [AOR] [95% CI], 2.1 [0.4-10.2], P = .37; 13- to 18-hour group AOR [95% CI], 0.8 [0.1-4.5], P = .81; 19- to 24-hour group AOR [95% CI], 1.1 [0.2-6.2], P = .90). Time to I&D did not affect the rate of nonunion, hardware failure, length of stay, or mortality.
  
  
  CONCLUSIONS
  In this prospective analysis, time to I&D did not affect the development of local infectious complications provided it was performed within 24 hours of arrival.
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Marissa
authors.initials: M
authors.lastname: Srour
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Obi
authors.initials: O
authors.lastname: Okoye
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Carney
authors.initials: C
authors.lastname: Chan
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Skiada
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Beat
authors.initials: B
authors.lastname: Schnüriger
authors.affiliation: Department of Orthopedic Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Mark
authors.initials: M
authors.lastname: Trump
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D007507:Therapeutic Irrigation; D061665:Time-to-Treatment; D014193:Trauma Centers; D016896:Treatment Outcome