Prospective Evaluation of Treatment of Open Fractures

The standard practice of irrigation and debridement (ID) of open fractures within 6 hours of injury remains controversial.To prospectively evaluate the effect of the time from injury to the initial ID on infectious complications.A total of 315 patients who were admitted to a level 1 trauma center with open extremity fractures from September 22, 2008, through June 21, 2011, were enrolled in a prospective observational study and followed up for 1 year after discharge (mean [SD] age, 33.9 [16.3] years; 79% were male; and 78.4% were due to blunt trauma). Demographics, mechanism of injury, time to ID, operative intervention, and incidence of local infectious complications were documented. Patients were stratified into 4 groups based on the time of ID (6 hours, 7-12 hours, 13-18 hours, and 19-24 hours after injury). Univariate and multivariable analysis were used to determine the effect of time to ID on outcomes.Development of local infectious complications at early (30 days) or late (30 days and1 year) intervals from admission.The most frequently injured site was the lower extremity (70.2%), and 47.9% of all injuries were Gustilo classification type III. There was no difference in fracture location, degree of contamination, or antibiotic use between groups. All patients underwent ID within 24 hours. Overall, 14 patients (4.4%) developed early wound infections, while 10 (3.2%) developed late wound infections (after 30 days). The infection rate was not statistically different on univariate (6 hours, 4.7%; 7-12 hours, 7.5%; 13-18 hours, 3.1%; and 19-24 hours, 3.6%; P = .65) or multivariable analysis (6-hour group [reference], P = .65; 7- to 12-hour group adjusted odds ratio [AOR] [95% CI], 2.1 [0.4-10.2], P = .37; 13- to 18-hour group AOR [95% CI], 0.8 [0.1-4.5], P = .81; 19- to 24-hour group AOR [95% CI], 1.1 [0.2-6.2], P = .90). Time to ID did not affect the rate of nonunion, hardware failure, length of stay, or mortality.In this prospective analysis, time to ID did not affect the development of local infectious complications provided it was performed within 24 hours of arrival.