The Importance of Early Operative Treatment in Open Fractures of the Fingers

Abstract

Current guidelines suggest early surgical treatment of open fractures. This rule in open hand fractures is not well supported and may be practically difficult to observe. Furthermore, desirable washout can be obtained in the emergency department (ED). The purpose of this study was to determine the importance of early surgery in our institution. Seventy patients with open fractures of the hand were retrospectively reviewed for demographics, fracture characteristics, and complications. Statistical analysis included univariate analysis, Fisher exact test, and Akaike information criterion. Intravenous antibiotics were administered early in 53 (75.7%) patients. Mean (SD) time to surgery was 2.3 (134.9) hours. The infection rate was 11.4%. No significant relationship was found between fracture type, finger involved, hand dominance, comorbidities, and infection. Antibiotic administration was significantly related to infection (P = 0.007), whereas time to surgery was not (P = 0.33). Age was weakly related to infection (P = 0.08). Administration of intravenous antibiotics in the ED was the most significant factor in preventing infection, whereas the time to operation was not significant. Because a thorough washout and debridement can be performed on open hand fractures in the ED due to the ability to provide adequate anesthesia, the actual time to surgery may possibly be delayed without increasing the risk of infection. Future prospective studies may allow for better guidelines for the treatment of open hand fractures.