Delayed debridement of open tibia fractures beyond 24 and 48 h does not appear to increase infection and reoperation risk.

Autor:	Heckmann, Nathanael D., Davis, Jason A., Mombell, Kyle, Bradley, Alexander, Chung, Brian C., Husak, Lisa, Marecek, Geoffrey
Předmět:	KRUSKAL-Wallis Test DEBRIDEMENT CONFIDENCE intervals MULTIVARIATE analysis MANN Whitney U Test TREATMENT delay (Medicine) RISK assessment COMPOUND fractures SURGICAL site infections REOPERATION DESCRIPTIVE statistics TIBIAL fractures DATA analysis software ODDS ratio LOGISTIC regression analysis DISEASE risk factors
Zdroj:	European Journal of Orthopaedic Surgery & Traumatology; Jul2022, Vol. 32 Issue 5, p953-958, 6p
Abstrakt:	Purpose: Surgical debridement is critical to the treatment of open tibia fractures, although the effects of delayed debridement have not been well-established. Other factors such as Gustilo-Anderson type, prompt initiation of antibiotics, and time to definitive closure may be more predictive of infection than time to surgery. We sought to determine the effect of a prolonged delay to surgical debridement with respect to infection and reoperation rates for open tibia fractures. Methods: All open diaphyseal tibia fractures with > 12-week follow-up were evaluated. Patient demographics, Gustilo-Anderson type, and rates of deep infection and all-cause reoperation were recorded. Patients were divided into 3 groups based on time to surgery: early (< 24 h), delayed (24–48 h), and late (> 48 h). Univariate and multivariate analyses were performed to evaluate the relationship between time to surgery, fracture type, infection, and reoperation. Results: In total, 96 open tibia fractures with average follow-up of 59.3 weeks and infection rate of 13.5% were included. Infection rates for the early, delayed, and late groups were 13.3%, 17.2%, and 9.1%, respectively (p = 0.70). Reoperation rates for the early, delayed, and late groups were 29.8%, 31.0%, and 22.7%, respectively (p = 0.80). The groups did not vary in proportion of Gustilo-Anderson fracture types; infection rates between Gustilo-Anderson types were similar (p = 0.57). Type IIIA-C fractures required more reoperations than other fracture types (p = 0.01). Conclusion: Delayed surgical debridement of open tibia fractures did not result in greater rates of infection or reoperation. Gustilo-Anderson classification was more predictive of reoperation, with Type IIIA-C injuries having a significantly higher reoperation rate. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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