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ObjectiveThe purpose of this study was to determine the association between time to initial debridement and infection rate in high-energy (grade III) open fractures of tibia.MethodsAll patients presenting with open fractures were included in the study. The inclusion criteria were Gustilo III A, B and C open fractures of tibia. Time of injury, time of arrival to the hospital, time of initial debridement and subsequent soft tissue procedures were recorded. The primary outcome measure was a diagnosis of infection or osteomyelitis at 1 year. Secondary outcome measure was fracture union at 1 year.ResultsSixty-seven (67) patients with grade III open fractures were included; the mean age was 32.4 years (54 males and 13 females). Eight patients (12 %) in this study went on to develop a deep infection, and there were 6 (8.4 %) non-unions. The infection rate for patients in the group who underwent debridement in less than 6 h and those greater than 6 h was 13.1 and 10.8 %, respectively. No statistically significant difference could be demonstrated between the two groups (p = 0.56). While there was no significant relationship between grade of fracture and infection rate (p = 0.07), the relationship between grade of fracture and non-union was significant (p = 0.02).ConclusionOur study shows that the risk of developing an infection was not increased if the primary surgical management was delayed more than 6 h after injury. Therefore, reasonable delays in surgical treatment for patients with open fractures may be justified in order to provide an optimal operating environment.

Therapeutic, Level IV, retrospective case study.

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The Achilles tendon is the most frequently ruptured tendon in the lower limb and comprises approximately 20% of all large tendon ruptures.Spontaneous rupture of the Achilles tendon is usually observed in healthy, active individuals in the third to fifth decades of life and is twice as common in males. It usually occur following high-performance activities.The authors report a case of unusual presentation of bilateral simultaneous Achilles tendon ruptures that occurred following a low-effort-level sport and in the absence of risk factors. In the case presented, nonoperative treatment led to a successful outcome.