The success of single débridement and primary closure of acute postoperative infections after open reduction and internal fixation

Abstract

Background: The development of surgical site infection in the presence of hardware after open reduction and internal fixation is an ongoing dilemma. There are no evidence-based guidelines to guide the number of surgical débridements and irrigations before definitive wound closure. The purpose of the present study was to assess the prevalence of infection resolution using a single debridement and primary wound closure in the acute postoperative infection and to identify risk factors for failure of single débridements and primary wound closure. Methods: We retrospectively reviewed 61 postoperative infections (60 patients) after open reduction and internal fixation of fractures that were treated with a single débridement and primary closure. For the analysis, the cases were categorized as the success group (n=29) and the failure group (n=32). Data were collected from a review of the patients’ medical record. Variables were compared between the two groups using univariate and multivariate logistic regression analysis. Results: Twenty-nine infections (48%) in 28 patients achieved successful outcome after single débridement and primary closure without hardware removal. Risk factors for treatment failure, identified by multivariate analysis, were Orthopaedic Trauma Association (OTA) classification B and C fractures (odds ratio=2.489; 95% confidence interval=1.085, 5.713; P=0.031) and C-reactive protein at admission (odds ratio=1.019; 95% confidence interval=1.004, 1.034; P=0.014). Conclusions: Acute postoperative infection after open reduction and internal fixation treated by single débridement with primary closure and hardware retention is successful in only half of the infections. This result may be improved by patient selection based on certain risk factors.