Osteomyelitis in Grade II and III Open Tibia Fractures with Late Debridement

The effect of time delay on infection in open long-bone fractures: a 5-year prospective audit from a district general hospital

“…However, 77% of their grade III fractures were in the delayed group. 11 Other papers have shown no clear link with time to antibiotics or theatre. 9,10 Our audit revealed that 60% of open fractures were operated on within 6 h and 40% were delayed.…”

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

“…This 6 h time limit is based on an extrapolation of knowledge of bacterial doubling times and the clinical evidence for this time limit is conflicting. Kindsfater et al [4] showed a statistically significant reduction in the rate of osteomyelitis when patients were taken to the operating theatre within 5 h; conversely, there are many studies reporting no significant difference in infection rates when irrigation and debridement took place either side of the 6 h cut-off [5]. All military patients with open fractures will go to theatre immediately upon admission to role 3 facilities for an initial debridement and washout, this is repeated upon the day of arrival at role 4.…”

Time to Initial Operative Treatment Following Open Fracture Does Not Impact Development of Deep Infection

“…Numerous studies [1][2][3][4][5][6][7][8][9] have questioned the association between delayed surgical treatment and the development of deep infection in open long bone fractures. Schenker et al, 10 in a recent meta-analyses of 3539 open fractures, reported similar findings.…”