Open tibial fractures have traditionally been treated as surgical emergencies. However, the “golden eight hour rule” for emergent treatment of these injuries is based more on historic principles and in-vitro data. A substantial number of open tibial fractures referred to our hospital from the peripheral referral units have transport times in excess of eight hours. These circumstances provide the source for the present study of the effect of delay in initial treatment on the final outcome in terms of infection, delayed union, non-union, malalignment and failure of fixation. Between January 1998 and June 2001, 53 open tibial fractures were treated at our institution. The fractures were classified using the Gustilo classification. All patient had a minimum of one year’s follow-up. Patients were categorized into 4 groups based on the time delay from injury to surgery, namely those treated within 6 hours of injury, 6 to 12 hours, 12 to 18 hours and >
18 hours following injury. Following recognized methods of surgical toilet and wound debridement, treatment modalities included intramedullar nailing, external fixation and cast application. There were 22 Grade 1, 22 Grade II and 9 Grade 3 open fractures. Twenty-three received treatment within 6 hours of injury, 10 between 6 to 12 hours, 6 between 12 to 18 hours and 14 at more than 18 hours following injury. Forty three percent of cases with complications were in the group of patients treated within 6 hours of injury, 29% were in those treated between 6 to 12 hours, 7% were in those treated between 12 to 18 hours and 21% were in those treated at >
18 hours following injury. 27% of Grade I open fractures, 14% of Grade II fractures and 55% of Grade III fractures developed complications. Our experience indicates that the incidence of complications correlates more with the severity of the injury rather than with time from injury to treatment. In spite of early treatment, fractures treated within 6 hours of injury developed more complications in our series. Delays of 6 to 18 hours did not reflect a proportional increase in incidence of complications.
