Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma

Abstract

Objectives: To determine whether a time delay greater than 6h from injury to surgical debridement influences the infection rate in open fractures. Methods: During a period of 18 months, from October 2010 to March 2012, 151 open fractures were available for study in 142 patients in our hospital. The data were collected prospectively and the patients were followed up for 6 weeks. The patients were divided into two groups regarding the time delay from injury to surgical debridement (more or less than 6 hours). Results: Surgical debridement was carried out in less than 6h from injury in 90 (59.6%) fractures and after 6 hours from injury in 61 (40.4%) fractures. Infection rates were 12.22% and 13.24%, respectively. The global infection rate was 13.24%. Conclusion: A significantly increased infection rate was not observed in patients whose surgical debridement occurred more than 6h after injury. However, in the fractures of high-energy trauma, a statistically significant increase of the rate of infection was observed in those operated 6 hours after trauma. Level of Evidence II, Study Type Comparative and Prospective.

Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up

“…Where a study by Muller et al reports infection rates in up to 20.50% of patients with open fractures, other author's report an overall infection rate of 13.24%. 15 , 16 , 17 , 18 , 19 In the present study, acute infection rate of 25.62% and 20.79% in 2020 and 2019 respectively, was observed. The increase in the acute infection rates for the period in 2020 can be attributed to the fact that there was a delay in presentation/referral to the tertiary care setup and thus a delay in administration to the dose of the antibiotics.…”

“…Further, there was a delay in admission to surgical intervention done. Fernandes et al in their study found no statistical difference in the infection rates when debridement was done before 6 h and after 6 h, though they report increased infection rates in the patients operated after 6 h. 19 Further, they mentioned that a waiting time somewhere in the range of 6 h–24 h for the careful management of open fractures can allow better preoperative, better acknowledgment of the seriousness of related wounds, and thus satisfactory clinical stabilization. 19 No scientific conclusive data exists in the current literature reporting that the delay in surgical debridement leads to an increase in the incidence of infection.…”

Prophylactic surgical drainage is associated with increased infection following intramedullary nailing of diaphyseal long bone fractures: A prospective cohort study in Nigeria

“…Bone type was, perhaps surprisingly, not associated with SSI on multivariate analysis. There is evidence that infections are generally less common in upper extremity fractures as compared to lower extremity traumatic fractures [16,17]. The data for this variable in our study demonstrate a wide confidence interval, and our study is likely underpowered to detect a difference beyond that of differing infection rates among the entire patient cohort.…”

An Updated Evidence About the Role of Timing to Debridement on Infection Rate of Open Tibial Fractures: A Meta-Analysis

“…Nine retrospective studies [ 4 , 6 , 11 , 12 , 19 - 23 ] and six prospective studies [ 3 , 5 , 10 , 15 , 24 , 25 ] were included in the present meta-analysis study. The number of fractures ranged from 41 to 383 fractures.…”