The Effect of Surgical Delay on Acute Infection Following 554 Open Fractures in Children

Current Concepts and Principles in Open Tibial Fractures - Part II Management

“…The BOA/BAPRAS guideline stated "The origin of this 6 hours rule remains unclear; it is often quoted but is largely unreferenced". Several studies that call into question the urgency of open fracture care exist [12,13]. A recent metaanalysis evaluated how timing to debridement affects infectious complications in open long bone fractures.…”

“…A recent metaanalysis evaluated how timing to debridement affects infectious complications in open long bone fractures. They concluded that there was no association between delayed debridement and higher infection rates [12,13]. Skaggs and associates reviewed 554 open fractures in children and found only an association of time of antibiotic administration with decreases in infection rates.…”

“…Harley and colleagues reviewed 241 long bone fractures and recorded transport time from the field to hospital admission, which was frequently in excess of 8 hours. A weak association between debridement time after 13 hours and infection was found [12,13]. The role of extended transport time and delay in antibiotics was not explored.…”

“…Time to debridement was not predictive of infection. The investigators cited resuscitation and early administration of broad spectrum antibiotics, or either, as possible reasons for the importance of admission time [12,13]. Most studies conclude that time to debridement is not an independent predictor of deep infection for open fractures [2][3][4][5][6][7][8][9][10][11][12][13].…”

“…This therefore prevents further injury to the soft tissue envelope and preserves blood supply. It also has a positive effect on control of pain and limb oedema by improving perfusion and venous return of the affected limb [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The BOA/BAPRAS guidelines advocates the use of the spanning external fixator, however care needs to be taken on applying the external fixator as access to the wounds by the plastic surgeons is required for soft tissue reconstruction.…”