Traditional recommendations suggest that open fractures require urgent surgical debridement to reduce infection. Although many papers comparing early vs late debridement have found no difference in infection rates, these papers have not taken into account important confounding factors. We attempt to answer whether delay between injury and surgical debridement in open fractures is associated with a higher infection rate after accounting for these important confounders. Five hundred and twenty three open extremity fractures in 417 patients were identified using the Sunnybrook trauma and orthopaedic department registries. Thirty patients (36 fractures) did not have complete follow-up. Seven patients were excluded due to incomplete data (complete follow-up rate=91%). A further 14 patients died during their hospitalization. A total of 459 fractures in 364 patients were reviewed. Data was collected on demographics, ISS score, ASA, time to initial operative debridement, timing of antibiotic administration, mechanism of injury, presence of significant contamination, and Gustillo-Anderson fracture grade. Deep infection was defined as an unplanned return to the operating room for treatment of infection. The influence of time to initial debridement was examined in an unadjusted analysis as a continuous variable and at thresholds of 6 and 12 hours of delay. A multivariable logistic regression was used to analyze the effect of delay while controlling for important confounding variables.Purpose
Method
Traditional recommendations suggest that open fractures require urgent surgical debridement to reduce infection. However, this has recently been challenged by a number of investigations. However, in many cases, these studies were not able to control for important confounding factors. The purpose of our study was to evaluate the relationship between delay to definitive surgical debridement while controlling for important confounders. 364 patients with 459 open fractures treated at a level one trauma centre over four years were reviewed. Time to definitive surgical debridement was modelled as a predictor of infection while controlling for fracture grade, anatomic site of fracture, and presence of significant contamination. Time to debridement was modelled as both a continuous variable and a categorical variable with cut off points at 6 and 12 hours of delay.Background
Method
