New Scoring System Predicting the Occurrence of Deep Infection in Open Tibial Fractures: Preliminary Report

Abstract

It is important to predict the occurrence of deep infection in open fractures when treating such fractures. We tried to develop a new scoring system for predicting the occurrence of deep infection in open tibial fractures on the basis of the Hannover Fracture Scale '98 (HFS-98). A total of 202 open tibial fractures (195 patients) were retrospectively reviewed in the initial analysis. The relationship between Gustilo's grade and the eight items on the HFS in the open tibial fractures was first investigated by multivariate analysis. By this analysis, we selected significant items that correlated with Gustilo's grade. Among these cases, 179 patients with 185 open tibial fractures were used for the following infection analyses. The relationships between the incidence of deep infection and age (<46 years, 46-60 years, <60 years), grade of trauma (ISS <18, 18 < or = ISS < or = 30, ISS > 30), fracture location, or some significant items in the above initial analysis were further analyzed by multivariate analysis after univariate analysis. We devised a new scoring system of open tibial fractures based on p values in the above analysis. The discrimination of the newly devised scoring system was evaluated with receiver operating characteristic curves. The following were significant factors affecting the occurrence of deep infection on multivariate analysis: bone loss (p = 0.012); muscle injury (p = 0.012); wound contamination (p = 0.0001); and local circulation (p = 0.0001). We devised a new scoring system for open tibial fractures (bone loss: 0-20 points, muscle injury: 0-20 points, wound contamination: 0-30 points, and local circulation: 0-30 points). The cut-off point for occurrence of deep infection in these fractures was 60 by receiver operating characteristic analysis. This new scoring system was thought to be useful for predicting the occurrence of deep infection in open tibial fractures. However, further prospective study or extension of this scale for other open fractures would be needed.