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Delayed debridement of open tibia fractures beyond 24 and 48 h does not appear to increase infection and reoperation risk

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Surgical debridement is critical to the treatment of open tibia fractures, although the effects of delayed debridement have not been well-established. Other factors such as Gustilo-Anderson type, prompt initiation of antibiotics, and time to definitive closure may be more predictive of infection than time to surgery. We sought to determine the effect of a prolonged delay to surgical debridement with respect to infection and reoperation rates for open tibia fractures.

Methods

All open diaphyseal tibia fractures with > 12-week follow-up were evaluated. Patient demographics, Gustilo-Anderson type, and rates of deep infection and all-cause reoperation were recorded. Patients were divided into 3 groups based on time to surgery: early (< 24 h), delayed (24–48 h), and late (> 48 h). Univariate and multivariate analyses were performed to evaluate the relationship between time to surgery, fracture type, infection, and reoperation.

Results

In total, 96 open tibia fractures with average follow-up of 59.3 weeks and infection rate of 13.5% were included. Infection rates for the early, delayed, and late groups were 13.3%, 17.2%, and 9.1%, respectively (p = 0.70). Reoperation rates for the early, delayed, and late groups were 29.8%, 31.0%, and 22.7%, respectively (p = 0.80). The groups did not vary in proportion of Gustilo-Anderson fracture types; infection rates between Gustilo-Anderson types were similar (p = 0.57). Type IIIA-C fractures required more reoperations than other fracture types (p = 0.01).

Conclusion

Delayed surgical debridement of open tibia fractures did not result in greater rates of infection or reoperation. Gustilo-Anderson classification was more predictive of reoperation, with Type IIIA-C injuries having a significantly higher reoperation rate.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033, USA

    Nathanael D. Heckmann & Brian C. Chung

  2. Department of Orthopaedic Surgery, University of California San Francisco Fresno, Fresno, CA, USA

    Jason A. Davis & Lisa Husak

  3. Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA

    Kyle Mombell

  4. Department of Orthopaedic Surgery, University of Chicago, Chicago, IL, USA

    Alexander Bradley

  5. Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Geoffrey Marecek

Authors
  1. Nathanael D. Heckmann
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  2. Jason A. Davis
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  3. Kyle Mombell
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  4. Alexander Bradley
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  5. Brian C. Chung
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  6. Lisa Husak
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  7. Geoffrey Marecek
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Correspondence to Nathanael D. Heckmann.

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Conflicts of interest

Authors GM and NDH have relevant financial activities outside the submitted work (see uploaded ICMJE Form for Disclosure of Potential Conflicts of Interest). Authors AB, BCC, JAD, KM, and LH have no relevant financial or non-financial interests to disclose.

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This study was approved by the appropriate institutional review committee (institutional review board) at our institution and meets the guidelines set forth by the responsible governmental agency.

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Heckmann, N.D., Davis, J.A., Mombell, K. et al. Delayed debridement of open tibia fractures beyond 24 and 48 h does not appear to increase infection and reoperation risk. Eur J Orthop Surg Traumatol 32, 953–958 (2022). https://doi.org/10.1007/s00590-021-03057-2

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  • DOI: https://doi.org/10.1007/s00590-021-03057-2

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