Primary Wound Closure After Open Fracture: A Prospective Cohort Study Examining Nonunion and Deep Infection
| Autor: | Khaled Alabassi, Sukhdeep Dulai, Stephanie Smith, Lauren A Beaupre, Joseph W. Bergman, Donald Weber, Angela Scharfenberger |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male musculoskeletal diseases medicine.medical_specialty animal structures Adolescent Nonunion Comorbidity Alberta Cohort Studies Fractures Open Young Adult 03 medical and health sciences 0302 clinical medicine Risk Factors Prevalence medicine Humans Surgical Wound Infection Orthopedics and Sports Medicine Femur Humerus Prospective Studies 030212 general & internal medicine Tibia Fibula Prospective cohort study Fractures Malunited Aged Aged 80 and over 030222 orthopedics Wound Closure Techniques business.industry Ulna General Medicine Middle Aged musculoskeletal system medicine.disease Surgery Causality Treatment Outcome medicine.anatomical_structure Female Wound closure business |
| Zdroj: | Journal of Orthopaedic Trauma. 31:121-126 |
| ISSN: | 0890-5339 |
| Popis: | Determine the proportion of subjects developing deep infection or nonunion after primary wound closure of open fractures (humerus, radius/ulna, femur, and tibia/fibula). Secondarily, a matched-series analysis compared outcomes with subjects who underwent delayed wound closure.Prospective cohort between 2009 and 2013 of subjects undergoing primary closure.Trauma center.Eighty-three (84 fractures) subjects were enrolled. Eighty-two (99%) subjects (83 fractures) provided follow-up data. Matching (age, sec, fracture location, and grade) was performed using study data of delayed wound closure undertaken at the same center between 2001 and 2009 (n = 68 matched subjects).Primary wound closure occurred when the fracture grade was Gustilo grade 3A or lower and the wound deemed clean at initial surgery. Standardized evaluations occurred until the fracture(s) healed; phone interviews and chart reviews were also undertaken at 1 year.Deep infection is defined as infection requiring unplanned surgical debridement and/or sustained antibiotic therapy after wound closure; nonunion is defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing 1-year after fracture.Three (4%) subjects had deep infections, whereas 10 (12%) subjects developed nonunion in the primary closure cohort. In the matched analyses [n = 68 pairs; (136 subjects)], the primary closure cohort had fewer deep infections [n = 3 (4%) vs. n = 6 (9%)] and nonunions [n = 9 (13%) vs. n = 19 (29%)] than the delayed closure cohort (P0.001).Primary wound closure after an open fracture appears acceptable in appropriately selected patients and may reduce the risk of deep infection and nonunion compared with delayed closure; a definitive randomized trial is needed.Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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