title: Primary Wound Closure After Open Fracture: A Prospective Cohort Study Examining Nonunion and Deep Infection.
abstract: OBJECTIVE
  Determine the proportion of subjects developing deep infection or nonunion after primary wound closure of open fractures (humerus, radius/ulna, femur, and tibia/fibula). Secondarily, a matched-series analysis compared outcomes with subjects who underwent delayed wound closure.
  
  
  METHODS
  Prospective cohort between 2009 and 2013 of subjects undergoing primary closure.
  
  
  METHODS
  Trauma center.
  
  
  METHODS
  Eighty-three (84 fractures) subjects were enrolled. Eighty-two (99%) subjects (83 fractures) provided follow-up data. Matching (age, sec, fracture location, and grade) was performed using study data of delayed wound closure undertaken at the same center between 2001 and 2009 (n = 68 matched subjects).
  
  
  METHODS
  Primary wound closure occurred when the fracture grade was Gustilo grade 3A or lower and the wound deemed clean at initial surgery. Standardized evaluations occurred until the fracture(s) healed; phone interviews and chart reviews were also undertaken at 1 year.
  
  
  METHODS
  Deep infection is defined as infection requiring unplanned surgical debridement and/or sustained antibiotic therapy after wound closure; nonunion is defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing 1-year after fracture.
  
  
  RESULTS
  Three (4%) subjects had deep infections, whereas 10 (12%) subjects developed nonunion in the primary closure cohort. In the matched analyses [n = 68 pairs; (136 subjects)], the primary closure cohort had fewer deep infections [n = 3 (4%) vs. n = 6 (9%)] and nonunions [n = 9 (13%) vs. n = 19 (29%)] than the delayed closure cohort (P < 0.001).
  
  
  CONCLUSIONS
  Primary wound closure after an open fracture appears acceptable in appropriately selected patients and may reduce the risk of deep infection and nonunion compared with delayed closure; a definitive randomized trial is needed.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Departments of *Surgery; †Infectious Diseases; and ‡Physical Therapy, University of Alberta, Edmonton, AB, Canada.
authors.forename: Angela V
authors.initials: AV
authors.lastname: Scharfenberger
authors.forename: Khaled
authors.initials: K
authors.lastname: Alabassi
authors.forename: Stephanie
authors.initials: S
authors.lastname: Smith
authors.forename: Donald
authors.initials: D
authors.lastname: Weber
authors.forename: Sukhdeep K
authors.initials: SK
authors.lastname: Dulai
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Bergman
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beaupre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D017759:Fractures, Malunited / Q000453:epidemiology* / Q000517:prevention & control*; D005597:Fractures, Open / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000706:statistics & numerical data*; D055815:Young Adult