Time to debridement in open high-grade lower limb fractures and its effect on union and infections: A prospective study in a tropical setting.

Autor:	Joseph CM; Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India., Jepegnanam TS; Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India., Ramasamy B; Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India., Cherian VM; Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India., Nithyananth M; Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India., Sudarsanam TD; Department of Medicine Unit 2, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India., Premkumar PS; Department of Biostatistics and Wellcome Trust Research Laboratory, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India.
Jazyk:	angličtina
Zdroj:	Journal of orthopaedic surgery (Hong Kong) [J Orthop Surg (Hong Kong)] 2020 Jan-Apr; Vol. 28 (1), pp. 2309499020907558.
DOI:	10.1177/2309499020907558
Abstrakt:	Purpose: To prospectively evaluate whether time to debridement has any correlation with union, infection, and quality of life in high-grade lower limb fractures in a tropical setting. Methods: A prospective cohort study was conducted at a tertiary care center in South India. Two hundred fifty-four adult skeletally mature patients with 301 grade 3 fractures involving the femur, tibia, or fibula were recruited. The cohort was empirically divided into two groups (early and late) based on the time to debridement (less than or more than 12 h from injury). Outcome: The primary outcome was nonunion. Secondary outcomes were deep infection rates and patients' quality of life. Short form-36 (SF-36) and short musculoskeletal functional assessment (SMFA) questionnaires were also used. Patients were followed up for 9 months. Results: The follow-up rate was 93%. The late group had a significantly higher risk of nonunion (odds ratio(OR): 6.5, 95% confidence interval (CI): 2.82-14.95) and infections (OR: 6.05, 95% CI: 2.85-12.82). There was a 4% increase in the infection risk for each hour of delay for the initial 50 h ( p < 0.0001). SF-36 and SMFA scores were superior in the early group ( p < 0.0001). Conclusion: The study contradicts findings reported in the literature from the West. Our study was in agreement with our hypothesis and proved that debridement within 12 h resulted in significantly lower rates of nonunion and infections and an overall improved quality of life in high-grade open lower limb fractures in a developing country. Level of Evidence: Level II. Trial Registration: German Clinical Trials Register DRKS00015186.
Databáze:	MEDLINE
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