Abstract
AIM: Assess the effect of delay in treatment greater than 24 hours on the development of infection for open tibia fractures. MATERIALS & METHODS: A retrospective review of all patients was conducted to identify skeletally mature patients with an open tibia fracture treated with the Surgical Implant Generation Network (SIGN) intramedullary nail from February 2006 and June 2015. Descriptive data, time to treatment, fracture characteristics, and presence of infection were collected and analyzed. RESULTS: Infection occurred in 19 (11%) patients (Gustilo I 1/44, 2%; Gustilo II 6/39, 15%, Gustilo IIIa 9/44, 21%; Gustillo IIIb 3/44, 7%). One hundred forty-four patients were treated within 24 hours from injury (mean, 8.2 hours) and 28 were treated after 24 hours (mean, 41.1 hours). There was no significant difference in the rates of infection for fractures before or after six hours from the time of injury (15% vs. 11%, P = 0.6207). Infection rate was similar in patients treated within 24 hours and beyond 24 hours (10% vs. 14%, P = 0.518). The average time to treatment of patients with and without infectious outcome were not significantly different (15.6 vs 13.4 hours, P = 0.700). There was an association between more severe Gustilo types and infection, yet this did not reach significance (P = 0.402) CONCLUSION: Our results show that initial treatment beyond 24 hours did not lead to a significant increase in the rate of infection. While not significant, a greater proportion of infections occurred in higher Gustilo types. Our results suggest that fracture type rather than time to treatment may be a more important predictor of infection.
Highlights
The most frequent complication of open fractures, with a reported incidence of 3 to 40%, is infection[1]
Treatment protocols advocated that initial treatment of open fractures within six hours reduced the risk of infection
The purpose of this study is to retrospectively examine the effect of delayed treatment on infection rates in open tibia fractures on a scale that has not previously been examined
Summary
The most frequent complication of open fractures, with a reported incidence of 3 to 40%, is infection[1]. An unwritten “six-hour rule” has developed within the orthopaedic community; it is widely advocated that initiating treatment within six hours of injury reduces the rate of morbidity and mortality[6,7,8,9]. Little scientific evidence has supported this “six-hour rule” but the exact time in which the risk of infection increases remains unknown. AIM: Assess the effect of delay in treatment greater than 6 and 24 hours on the development of infection for open tibia fractures. There was no significant difference in the rates of infection for fractures treated before or after six hours from the time of injury (15% vs 11%, p = 0.621). CONCLUSION: Our results show that initial treatment beyond 24 hours did not lead to a significant increase in the rate of infection. Our results suggest that fracture type rather than time to treatment may be a more important predictor of infection
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