PRIMARY WOUND CLOSURE IN OPEN TIBIAL FRACTURES

Abstract

Introduction and Aims: Primary wound closure in open tibial fractures has not been recommended. Studies suggest that infections are not caused by the initial contamination but the organisms acquired in the hospital. Primary wound closure after adequate wound care and fracture stabilisation should be a safe concept.

Method: We analysed 95 patients with open tibial fractures Gustilo-Anderson Type 1-3a treated with primary fracture stabilisation and delayed wound closure (group I) and primary fracture stabilisation and primary wound closure (group II). In group I, 46 patients (38 males, eight females) with a mean age of 30.2 years (range 16–56) were included. In group II, 49 patients (36 males, 13 females) with a mean age of 33.4 (range 18–69) were included. The mean follow-up in group I was 11.5 (range 9–18) and 11.7 (range 8–16) months.

Results: The mean operating time in group I was 96 (range 45–180) minutes, in group II, 101 (range 40–170) minutes. The hospital stay in group I was 8.6 (range 3–20) days and in group II, 15.4 (range 4–52) days. One infectious case in group I was seen (2%) and two cases in group II (4.3%) were found. On further analysis, one case in group II, in our opinion, should not have been treated with primary fixation and wound closure. He only had three doses of a first generation cephalosporin and was operated 20 hours after admission to hospital. The corrected infection rate in group II should therefore should be calculated without that case and then is 2.1%.

Conclusions: Our results support recent findings that primary wound closure after thorough debridement in Grade I and II open fractures does not increase the infection rate in comparison to the standard treatment. It shortens hospital stay and is cost-effective treatment. We conclude that primary wound closure is safe.