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Purpose: To prospectively evaluate whether time to debridement has any correlation with union, infection, and quality of life in high-grade lower limb fractures in a tropical setting. Methods: A prospective cohort study was conducted at a tertiary care center in South India. Two hundred fifty-four adult skeletally mature patients with 301 grade 3 fractures involving the femur, tibia, or fibula were recruited. The cohort was empirically divided into two groups (early and late) based on the time to debridement (less than or more than 12 h from injury). Outcome: The primary outcome was nonunion. Secondary outcomes were deep infection rates and patients’ quality of life. Short form-36 (SF-36) and short musculoskeletal functional assessment (SMFA) questionnaires were also used. Patients were followed up for 9 months. Results: The follow-up rate was 93%. The late group had a significantly higher risk of nonunion (odds ratio(OR): 6.5, 95% confidence interval (CI): 2.82–14.95) and infections (OR: 6.05, 95% CI: 2.85–12.82). There was a 4% increase in the infection risk for each hour of delay for the initial 50 h ( p < 0.0001). SF-36 and SMFA scores were superior in the early group ( p < 0.0001). Conclusion: The study contradicts findings reported in the literature from the West. Our study was in agreement with our hypothesis and proved that debridement within 12 h resulted in significantly lower rates of nonunion and infections and an overall improved quality of life in high-grade open lower limb fractures in a developing country. Level of evidence: Level II Trial registration: German Clinical Trials Register DRKS00015186

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Head preservation of an infected neck of femur fracture appears to be extremely rare with no described cases in literature till date. We present the outcome of head salvage in a young adult with an infected neck of femur nonunion who in addition had chronic osteomyelitic sequelae of his entire femur with reactivation of latent infection in the distal femoral diaphysis. Osteosynthesis was performed by means of cancellous screw fixation augmented with bone substitute following a failed attempt at salvage with a valgus intertrochanteric osteotomy. The patient had an excellent functional outcome with near normal hip range of movements at a follow-up of 5 years after union.

This is the first report of a long-term follow-up of an open bicondylar Hoffa with patella fracture. It is interesting to note the radiological changes of osteoarthritis 15 years after global intra-articular injury of the distal femur. The good clinical outcome is possibly due to the integrity of the knee ligaments and reconstruction of the extensor mechanism in addition to stable anatomical reduction and fixation.