Fracture Site Motion and Infection

Abstract

Treatment of open fractures is often complicated by the development of infection. The wound in these cases is generally contaminated and extensive irrigation and debridement is needed to cleanse the area. Despite these attempts at cleansing, the more severe fractures carry a high infection rate (1). In addition to the problem of the highly contaminated tissue in the wound, the fractures are often extensive and difficult to align, the patient usually has multiple injuries complicating the nursing care, and patient management would be better if the fracture were internally fixed. However it is well known that the insertion of a foreign body such as a suture or internal fixation device into a contaminated area greatly increases the risk of infection. The advantages of fracture alignment and stabilization which will minimize the movement of bony fragments and lessen tissue damage need to be considered against the disadvantages imposed by the presence of a foreign body. Many orthopaedic surgeons feel that the advantages of internal fixation outweigh the disadvantages of the wound infections and osteomyelitis which occur and recommend internal fixation of open fractures (1–3). It is difficult when evaluating the situation in the human patients with open fractures to distinguish what are the important variables. No two patients arrive in the emergency room with the same type of fracture, the same level of microbial contamination, and the same level of underlying disease or multiple trauma. Thus it is necessary to use an animal model to investigate the role of internal fixation in the development of infection in open fractures.