Institutional delay in wound coverage increases postoperative complications in patients with traumatic open fractures

Abstract

Background: Open fractures often require additional procedures for timely definitive soft-tissue coverage. Delayed coverage is associated with poor outcomes. Thus, we sought to (1) define the incidence and severity of open fractures presenting to our institution, (2) identify soft-tissue coverage methods, and (3) determine the incidence of postoperative complications. Materials and Methods: Patients were identified in our institutional registry through the International Classification of Diseases (ICD)-9 and ICD-10 codes specific for open long-bone and extremity fractures. Descriptive statistics were performed on demographics, injury mechanism, and fracture type (Gustilo–Anderson classification). Fractures requiring coverage (Type IIIB/C), surgical methods, and duration until coverage (mean days ± standard deviation) were recorded. Postoperative complications were also identified. Results: From 2012 to 2017, 243 patients were treated for open long-bone fractures. Blunt trauma accounted for 76.9% (n = 187) of the injuries. Grade III tibia fractures represented the highest incidence (n = 74, 30.4%). Of the IIIB/C injuries, the most common coverage methods were split-thickness skin grafting (n = 24, 32.4%) occurring 16.2 ± 11.5 (range: 3–40) days following injury and rotational flap coverage (n = 22, 29.7%). IIIB/C injuries were complicated by nonunion (n = 11, 14.9%), infection (n = 12, 16.2%), amputation (n = 21, 28.4%), and wound breakdown (n = 7, 9.5%). Conclusions: High-grade open fractures treated without timely definitive coverage can result in complications. Multiple specialties may be required to manage these patients, and it may be beneficial for orthopedic surgeons to obtain skills in skin grafting and rotational muscle flap coverage to decrease time to definitive wound closure.