Abstract
Aims
To determine whether a delay of greater than 6 hrs from injury to initial surgical debridement and the timing of antibiotic administration affect infection rates in open long-bone fractures in a typical district general hospital in the UK.
Methods
In a prospective study, 248 consecutive open long-bone fractures (248 patients) were recruited over a 10-year period between 1996 and 2005. The data were collected in weekly audit meetings. Patients were followed until clinical or radiological union occurred or until a secondary procedure for non-union or infection was performed. The timing of the injury, initial surgical debridement, timing of antibiotic administration, and definitive procedures were all recorded. We also recorded the bone involved and the Gustillo and Anderson (GA) score. Patients who died within 3 months from the injury or who were transferred for definitive treatment were excluded.
Results
Surgical debridement was performed before 6 hrs from injury in 62% of cases and after 6 hrs in 38% of cases. Infection rates were 7.8% and 9.6% respectively. The difference between the two groups was found to be not statistically significant (p=0.6438). This study has a 97% chance of demonstrating a difference of 20% (beta=0.2). The timing of administration of antibiotics was not found to be significantly related to the rate of infection; however, the GA grade of the injury had a strong correlation with subsequent infection.
Conclusion
There was no significant rise in infection in patients receiving initial debridement after 6 hrs from the injury in comparison to patients who had this debridement within the 6-hour period. Whilst surgical debridement should be performed in the acute setting, we suggest that adherence to a 6-hour window is not imperative. Furthermore, the timing of antibiotic administration during the acute phase had little effect on infection rates.
