Skip to main content

Advertisement

SpringerLink
Log in

Timing issue in open fractures debridement: a review article

  • General Review
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Open fractures constitute a major trauma mostly sustained by young adults during high-energy injuries. Management of long bone open fractures is a very complex issue and is often complicated by nonunion and deep infection being among the most devastating and difficult to cure. It is generally recommended that wound debridement and stabilization of open fractures should be performed as early as possible, preferably within 6–8 h on the basis of historical comment and laboratory data. The rationale for this rule is believed to originate from Freidrich’s historical study of guinea pigs. The literature lacks strong evidence addressing the primary issue of timing and delay on the incidence of deep infection and nonunion in open fractures. In the light of the actual literature regarding this topic, it seems that time to debridement of open fractures is not a prognostic factor of infection as well as nonunion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ikem IC, Oginni LM, Bamgboye EA (2001) Open fractures of the lower limb in Nigeria. Int Orthop 25:386–388

    Article  PubMed  CAS  Google Scholar 

  2. Harley BJ, Beaupre LA, Jones CA, Dulai SK, Weber DW (2002) The effect of time to definitive treatment on the rate of nonunion and infection in open fractures. J Orthop Trauma 16:484–490

    Article  PubMed  Google Scholar 

  3. Khatod M, Botte MJ, Hoyt DB, Meyer RS, Smith JM, Akeson WH (2003) Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma 55:949–954

    Article  PubMed  Google Scholar 

  4. Ashford RU, Mehta JA, Cripps R (2004) Delayed presentation is no barrier to satisfactory outcome in the management of open tibial fractures. Injury 35:411–416

    Article  PubMed  Google Scholar 

  5. Charalambous CP, Siddique I, Zenios M, Roberts S, Samarji R, Paul A, Hirst P (2005) Early versus delayed surgical treatment of open tibial fractures: effect on the rates of infection and need of secondary surgical procedures to promote bone union. Injury 36:656–661

    Article  PubMed  CAS  Google Scholar 

  6. Bednar DA, Parikh J (1993) Effect of time delay from injury to primary management on the incidence of deep infection after open fractures of the lower extremities caused by blunt trauma in adults. J Orthop Trauma 7:532–535

    Article  PubMed  CAS  Google Scholar 

  7. Court-Brown CM, Rimmer S, Prakash U, McQueen MM (1998) The epidemiology of open long bone fractures. Injury 29:529–534

    Article  PubMed  CAS  Google Scholar 

  8. Giannoudis PV, Papakostidis C, Roberts C (2006) A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br 88:281–289

    Article  PubMed  CAS  Google Scholar 

  9. Howard M, Court-Brown CM (1997) Epidemiology and management of open fractures of the lower limb. Br J Hosp Med 57:582–587

    PubMed  CAS  Google Scholar 

  10. Tripuraneni K, Ganga S, Quinn R, Gehlert R (2008) The effect of time delay to surgical debridement of open tibia shaft fractures on infection rate. Orthopedics 31(12):1–5

    Article  Google Scholar 

  11. Ruiz AL, Kealey WD, McCoy GF (2000) Implant failure in tibial nailing. Injury 31:359–362

    Article  PubMed  CAS  Google Scholar 

  12. Whittle AP, Russell TA, Taylor JC, Lavelle DG (1992) Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg Am 74:1162–1171

    PubMed  CAS  Google Scholar 

  13. Joshi D, Ahmed A, Krishna L, Lal Y (2004) Unreamed interlocking nailing in open fractures of tibia. J Orthop Surg (Hong Kong) 12:216–221

    CAS  Google Scholar 

  14. Park S, Ahn J, Gee AO, Kuntz AF, Esterhai JL (2009) Compartment syndrome in tibial fractures. J Orthop Trauma 23:514–518

    Article  PubMed  Google Scholar 

  15. Kindsfater K, Jonassen EA (1995) Osteomyelitis in grade II and III open tibia fractures with late debridement. J Orthop Trauma 9:121–127

    Article  PubMed  CAS  Google Scholar 

  16. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458

    PubMed  CAS  Google Scholar 

  17. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746

    Article  PubMed  CAS  Google Scholar 

  18. Patzakis MJ, Wilkins J (1989) Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res 243:36–40

    PubMed  Google Scholar 

  19. Berg E, Barth E, Clarke D, Dooley L (1989) The use of adjunctive hyperbaric oxygen in treatment of orthopedic infections and problem wounds: an overview and case reports. J Invest Surg 2:409–421

    Article  PubMed  CAS  Google Scholar 

  20. Patzakis MJ, Wilkins J, Moore TM (1983) Considerations in reducing the infection rate in open tibial fractures. Clin Orthop Relat Res 178:36–41

    PubMed  Google Scholar 

  21. Sungaran J, Harris I, Mourad M (2007) The effect of time to theatre on infection rate for open tibia fractures. ANZ J Surg 77:886–888

    Article  PubMed  Google Scholar 

  22. Gustilo RB, Merkow RL, Templeman D (1990) The management of open fractures. J Bone Joint Surg Am 72:299–304

    PubMed  CAS  Google Scholar 

  23. Wangensteen OH, Wangensteen SD (1973) Carl Reyher (1846–1890), great Russian military surgeon: his demonstration of the role of debridement in gunshot wounds and fractures. Surgery 74:641–649

    PubMed  CAS  Google Scholar 

  24. Crowley DJ, Kanakaris NK, Giannoudis PV (2007) Debridement and wound closure of open fractures: the impact of the time factor on infection rates. Injury 38:879–889

    Article  PubMed  CAS  Google Scholar 

  25. Fulkerson EW, Egol KA (2009) Timing issues in fracture management: a review of current concepts. Bull NYU Hosp Jt Dis 67:58–67

    PubMed  Google Scholar 

  26. Williams T, Meynell GG (1967) Time-dependence and count-dependence in microbial infection. Nature 214:473–475

    Article  PubMed  CAS  Google Scholar 

  27. Yokoyama K, Itoman M, Shindo M, Kai H (1995) Contributing factors influencing type III open tibial fractures. J Trauma 38:788–793

    Article  PubMed  CAS  Google Scholar 

  28. Burkhalter WE, Protzman R (1975) The tibial shaft fracture. J Trauma 15:785–794

    Article  PubMed  CAS  Google Scholar 

  29. Kreder HJ, Armstrong P (1995) A review of open tibia fractures in children. J Pediatr Orthop 15:482–488

    Article  PubMed  CAS  Google Scholar 

  30. Reuss BL, Cole JD (2007) Effect of delayed treatment on open tibial shaft fractures. Am J Orthop (Belle Mead NJ) 36:215–220

    Google Scholar 

  31. Naique SB, Pearse M, Nanchahal J (2006) Management of severe open tibial fractures: the need for combined orthopaedic and plastic surgical treatment in specialist centres. J Bone Joint Surg Br 88:351–357

    Article  PubMed  CAS  Google Scholar 

  32. Skaggs DL, Friend L, Alman B, Chambers HG, Schmitz M, Leake B, Kay RM, Flynn JM (2005) The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am 87:8–12

    Article  PubMed  Google Scholar 

  33. Spencer J, Smith A, Woods D (2004) The effect of time delay on infection in open long-bone fractures: a 5-year prospective audit from a district general hospital. Ann R Coll Surg Engl 86:108–112

    Article  PubMed  Google Scholar 

  34. Skaggs DL, Kautz SM, Kay RM, Tolo VT (2000) E 569 ffect of delay of surgical treatment on rate of infection in open fractures in children. J Pediatr Orthop 20:19–22

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subjects of this manuscript.

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Department, 12 de Octubre Hospital, Avd de Córdoba s/n, 28041, Madrid, Spain

    Alberto Jorge-Mora & Juan Pretell-Mazzini

  2. Trauma and Orthopaedic Surgery Department, Infanta Leonor Hospital, c/Gran Vía del Este, 80, 28031, Madrid, Spain

    Juan Rodriguez-Martin

Authors
  1. Alberto Jorge-Mora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan Rodriguez-Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan Pretell-Mazzini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juan Pretell-Mazzini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jorge-Mora, A., Rodriguez-Martin, J. & Pretell-Mazzini, J. Timing issue in open fractures debridement: a review article. Eur J Orthop Surg Traumatol 23, 125–129 (2013). https://doi.org/10.1007/s00590-012-0970-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-012-0970-7

Keywords

Search

Navigation