title: Management of Open Tibial Shaft Fractures: Does the Timing of Surgery Affect Outcomes?
abstract: BACKGROUND
  Open tibial shaft fractures require emergent care. Treatment with intravenous antibiotics and fracture débridement within 6 to 24 hours is recommended. Few studies have examined outcomes when surgical treatment is performed >24 hours after occurrence of the fracture.
  
  
  METHODS
  This retrospective study included 227 patients aged ≥18 years with isolated open tibial shaft fractures in whom the time to initial débridement was >24 hours. The statistical analysis was based on time from injury to surgical débridement, Gustilo-Anderson classification, method of fixation, union status, and infection status.
  
  
  RESULTS
  Fractures débrided within 24 to 48 hours and 48 to 96 hours after injury did not show a statistically significant difference in terms of infection rates (P = 0.984). External fixation showed significantly greater infection rates (P = 0.044) and nonunion rates (P = 0.001) compared with intramedullary nailing.
  
  
  CONCLUSIONS
  Open tibial shaft fractures should be débrided within 24 hours after injury. Our data indicate that after the 24-hour period and up to 4 days, the risk of infection remains relatively constant independent of the time to débridement. Patients treated with external fixation had more complications than did patients treated with other methods of fixation. Primary reamed intramedullary nailing appears to be a reasonable option for the management of Gustilo-Anderson types 1 and 2 open tibial shaft fractures.
  
  
  METHODS
  Level III retrospective study.
authors.affiliation: From the Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Oscar A
authors.initials: OA
authors.lastname: Duyos
authors.forename: David
authors.initials: D
authors.lastname: Beaton-Comulada
authors.forename: Ariel
authors.initials: A
authors.lastname: Davila-Parrilla
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Perez-Lopez
authors.forename: Krystal
authors.initials: K
authors.lastname: Ortiz
authors.forename: Christian
authors.initials: C
authors.lastname: Foy-Parrilla
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Gonzalez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult