Why Has the Outcome of Gustilo-Anderson Type III Fracture Not Improved over Two Decades?

Abstract

Introduction: Gustilo-Anderson type III injury is a complex injury that usually results from high-energy trauma. Such injuries tend to be intractable due to the high frequency of infection. Methods: A systematic review of the literature was performed using the MEDLINE database to investigate changes in infection rates in Gustilo-Anderson type III open fracture care over the past 20 years. Results: The results indicated that the incidence of postoperative infection in Gustilo-Anderson type III has not improved for approximately 20 years, occurring at a frequency similar to that in the early 20th century. Discussion and conclusion: The recommended treatment strategy for Gustilo-Anderson type III fractures is early initial debridement within 12 h and final bone coverage within 72 h. However, in reality, these ideal treatments are not always performed, which can lead to postoperative infection. Achieving early initial debridement and secondary bone coverage requires adequate resources in medical facilities, which is not viable as an immediate solution. Therefore, appropriate wound management should be performed to minimize the incidence of infection during the period awaiting surgery. Continuous irrigation therapy is considered a recommended treatment option.