Open Tibial Fractures Research Articles

Predictive factors for pin sites infection in external fixation of open tibia fractures

Objectives: External fixation is a readily available fixation method for some open tibia fracture grades. Pin site infection (PSI) is a common complication that leads to pin loosening and osteomyelitis. Understanding the predictive factor for PSI can reduce the incidence. This study aimed to determine the predictive factors for PSI in the external fixation of open tibia fractures. Methods: This was a prospective observational study. The biodemographic variables of the patient collected were age, sex, marital status, mechanism of injury, body mass index, number of pins inserted, pre-operative hematocrit, comorbidity, duration of the hospital stay, Gustilo/Andersen grades of open tibia fractures, and bacterial isolates among those with PSI. Results: Thirty patients who met the inclusion criteria were included in the study with a mean age of 45.9 years ± 17.7 with a male-to-female ratio of 3.3:1. Motor vehicle accidents and motorcycle/motor vehicle accidents were the predominant cause of injury in 56.7% of the patients. The incidence of PSI was 36.7%, with Staphylococcus aureus being the most common bacterial isolated at 81.8%. Only grades of open tibia fractures are the predictive factor for PSI (adjusted odds ratio 18.33, 95% confidence interval of 1.609–208.864, P = 0.019). Conclusion: The predictive factor that was statistically significantly associated with PSI in this study was the grades of the open tibia fractures.

External Fixator vs. Locking Compression Plate in “Supracutaneous” Mode for Open Distal Tibial Fractures: A Comparison on Economics, Union, Functional Outcome and Complications

Objectives Historically, in the pre-antiseptic era, there was a great fear of open tibial factors because of high incidence of infection eventually leading to amputation and in many cases septicemia and death. Despite improvements in surgical techniques in the last century, the optimum treatment for open type IIIa and Type II tibial farcture remains controversial. Literature available on use of Ex-fix as a definitive and permanent modality is very sparse and is not encouraging. In order to maintain biology of the fracture and to expedite the healing process many institutions and surgeons are using Locking compression plate as an external fixator which is fondly called as supracutaneous plating (SCP). Material and Methods The patients who had Gustilo and Anderson type II and IIIa # of distal Tibia were enrolled in this study. They were randomized into 2 groups. In one group (Ex-Fix) external fixator was applied in and in another group SCP was done. Four general indicators, including direct cost of hospitalization, first surgery time, time to full weight bearing, and time to complete union were compared between the groups. The functional outcome of the ankle was assessed. Presence of infection, Time to union was noted in both cases. Results Mean time to fracture union was statistically less in SCP group 5.84 months as compared to 7.21 months in Ex–fix group. Also, 12 patients in Ex-fix group had to undergo a reoperation as compare to only 1 in SCP group. This led to higher cost of expenditure and higher duration of stay in Ex-fix group. AOFAS Score, Teeny and Wiss were better in SCP group as compared to Ex-fix group. Conclusion Highlighting the role Of LCP in Supracutaneous mode as a definitive and final surgery , thus reducing the financial and psychological implication of reoperations in open grade and tibial fractures which are seen in patients managed with Ex-fix in definitive mode or as an interval for secondary nailing, we recommend the use of routine use of SCP in such tibial fractures after thorough debridement and diligent handling of soft tissue.

Relationship between number of debridements and clinical outcomes in open tibia fractures requiring free flap coverage: A retrospective cohort study

IntroductionOpen fractures with degloving injuries are commonly managed by serial debridements prior to definitive flap coverage in the United States (US). Some international institutions minimize the number of debridements prior to coverage. The purpose of this study was to compare clinical outcomes in patients with open tibia fractures requiring free flap coverage from institutions with differing debridement philosophies. MethodsThis was a multi-site retrospective cohort study of patients treated at two US tertiary care facilities (serial debridement cohort) and one in India (early total debridement cohort) with Type IIIB or IIIC open tibia fractures requiring free tissue transfer. The number of debridements prior to flap coverage were recorded and primary outcomes were rates of infection, non-union, and flap failure. Fischer's exact tests were used to compare outcomes between the cohorts. Results80 patients were included, 44 from India and 36 from the US. Patients in the serial debridement cohort underwent more debridements prior to flap coverage (mean 3.64 vs 1.84, p < 0.001) and had significantly higher rates of infection and non-union compared to patients in the early total debridement cohort (p < 0.05). There were no differences in rates of flap failure between the cohorts. ConclusionsPatients with open tibia fractures treated at institutions favoring serial debridements underwent more debridements and had higher rates of infection and non-union compared to patients treated at a center favoring early total debridement. Serial debridements may not be necessary prior to flap coverage for open tibia fractures and the current practice should be further investigated.

Functional outcomes and quality of life at 1-year follow-up after an open tibia fracture in Malawi: a multicentre, prospective cohort study

Injuries are a major cause of disability globally and injury incidence is rapidly increasing, largely due to road traffic injuries in low-income and middle-income countries. Current estimates of the scale and consequences of disability from injury are largely based on modelling studies, with a scarcity of empirical evidence from severe injuries in low-income countries. We aimed to better understand the outcomes for individuals with open tibia fractures in Malawi. In this multicentre, prospective cohort study, adults (aged ≥18 years) with open tibia fractures were systematically recruited at six hospitals in Malawi (two tertiary hospitals and four district hospitals). Follow-up lasted at least 1 year, during which in-person follow-up reviews were done at 6 weeks, 3 months, 6 months, and 1 year post-injury. The primary outcome was function at 1 year post-injury, measured by the Short Musculoskeletal Functional Assessment (SMFA) score. Secondary outcomes included quality-adjusted life-years (QALYs; as determined via the European Quality of Life 5-Dimensions 3-Levels [EQ-5D-3L] survey) and fracture-related infection at 1 year post-injury. Multilevel regression models investigated associations between SMFA score, EQ-5D-3L, baseline factors, and orthopaedic management. Between Feb 12, 2021, and March 14, 2022, 287 participants were enrolled (median age 34 years [IQR 25-44]; 84% male). The most common mode of injury was road traffic injuries (194 [68%] of 287). Overall, 268 (93%) participants had debridement; of the 63 participants who were debrided in district hospitals, 47 (75%) had the procedure under local or no anaesthesia. Following substantial declines by 6 weeks after injury, function and quality of life had not recovered by 1 year post-injury for participants with Gustilo grade I-II fractures (posterior mean SMFA at 1 year: 10·5, 95% highest density interval [HDI]: 9·5-11·6; QALYs: 0·73, 95% HDI: 0·66-0·80) nor Gustilo grade III fractures (posterior mean SMFA at 1 year: 14·9, 95% HDI: 13·4-16·6; QALYs: 0·67, 95% HDI: 0·59-0·75). For all fracture grades, intramedullary nailing substantially improved function and quality of life at 1 year post-injury. Delayed definitive fixation after 5 days had 5-times greater odds of infection compared with early management within 2 days (adjusted odds ratio: 5·1, 95% CI 1·8-16·1; p=0·02). Adults with open tibia fractures in Malawi have poor function and quality of life in the 1 year following injury. Centralised orthopaedic surgical management, including early definitive fixation and intramedullary nailing for more severe injuries, might improve outcomes. Wellcome Trust. For the Chichewa translation of the abstract see Supplementary Materials section.

Outcomes of open tibial fracture surgery: beyond the operating room

Outcomes of open tibial fracture surgery: beyond the operating room

The Laparoscopic Irrigator Aspirator: A Time and Cost Saving Alternative Irrigation Method for Open Fractures

Introduction: At our institution, the laparoscopic irrigator aspirator (LIA) is used as the primary means of irrigation in open fractures, as it allows for quicker and more efficient irrigation. The purpose of this technical trick is to evaluate the cost and time savings between gravity tubing, pulse lavage, and LIA methods. Materials and Methods: The 3 different methods of irrigation, gravity tubing, pulse lavage, and LIA, were set up, and the time to use one 3 L bag of normal saline was recorded for each. The list prices for each method of irrigation were obtained, and the time and cost saved per 3 L bag was multiplied by 3 for the total time and cost 9 L of irrigation. Results: The LIA was the most efficient irrigation method and saved 303 seconds over gravity and 534 seconds saved over pulse lavage over 9 L. For cost, the laparoscopic resulted in $156.15 saved over gravity and $332.80 saved over pulse lavage over 9 L when accounting for cost of operating room time and cost of implant. At our institution, 34 open tibia fractures were treated in 2019, which results in 2.86 hours and $5309.10 saved over gravity and 5.04 hours and $11,315.2 saved over pulse lavage by using the LIA. Conclusions: Lap irrigation is a viable alternative to gravity tubing and pulse lavage for open fracture irrigation and results in both time and cost savings.

Outcome of a 2-stage management of open tibia fracture in a low-income country lacking plastic surgeons: A retrospective cohort study

Outcome of a 2-stage management of open tibia fracture in a low-income country lacking plastic surgeons: A retrospective cohort study

Delays in Debridement of Open Femoral and Tibial Fractures Increase Risk of Infection.

Infection remains a costly, devastating complication following the treatment of open fractures. The appropriate timing of debridement is controversial, and available evidence has been conflicting. This study is a retrospective analysis of the SIGN (Surgical Implant Generation Network) Surgical Database (SSDB), a prospective registry of fracture cases in predominantly low-resource settings. Skeletally mature patients (≥16 years of age) who returned for follow-up at any time point after intramedullary nailing of an open femoral or tibial fracture were included. Patients were excluded if they had delays in debridement exceeding 7 days after the injury. Utilizing a model adjusting for potential confounders, including patient demographic characteristics, injury characteristics, country income level, and hospital type and resources, local logistic regression analysis was performed to evaluate the probability of infection with increasing time to debridement in 6-hour increments. In this study, 27.3% of patients met the eligibility criteria and returned for follow-up, with a total of 10,651 fractures from 61 countries included. Overall, the probability of infection increased by 0.17% for every 6-hour delay in debridement. On subgroup analysis, the probability of infection increased by 0.23% every 6 hours for Gustilo-Anderson type-III injuries compared with 0.13% for Gustilo-Anderson type-I or II injuries. The infection risk increased every 6 hours by 0.18% for tibial fractures compared with 0.13% for femoral fractures. There was a linear and cumulative increased risk of infection with delays in debridement for open femoral and tibial fractures. Such injuries should be debrided promptly and expeditiously. The size and international nature of this cohort make these findings uniquely generalizable to nearly all environments where such injuries are treated. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Pediatric floating knee injuries: Clinical modifiers affecting sports and transfer outcomes

AimThis study assessed the functional outcome, and the clinical modifiers that influence them with the aim to assist the clinician plan a better management strategy in Paediatric Floating Knee (PFK) injuries. MethodsA quasi-prospective, single-center observational study was designed to determine the functional and radiological outcomes in children (</= 16 years), with minimum 1 year follow-up after treatment for PFK from 01–01–2014 to 01–08–2019. A retrospective audit was conducted, and a prospective patient/parent reported outcome score was determined with the Pediatric Outcome Data Collection Instrument (PODCI) questionnaire for ‘transfer and mobility’ and ‘sports and physical function’. ResultsOf 32 patients with PFK injury, twenty-five patients with a mean follow-up of 43 months (SD = 18) who completed the PODCI questionnaire were analysed. Fourteen (56%) children had open fractures (Lett's D or E types) with 6 open femur and 12 open tibia fractures. Majority underwent surgical fixation, 8 children required staged reconstruction and 11 children required soft tissue procedure in the ipsilateral limb. The mean time to union for femur and tibia fractures was 3.86 months (SD = 5.3) and 3.5 months (SD = 2.9), respectively with delayed union/non-unions in 3 femoral and 4 tibial fractures. The mean knee range of movement (RoM) was 102° (SD = 34.1) with limb shortening in 6 children, and overgrowth in 3 children. The mean normative PODCI (transfer) score was 35.6 (normal range: -74 to 52) and mean PODCI (sports) score was 37.6 (normal range: -33 to 56). Both the PODCI scores demonstrated strong inverse correlation with higher ISS(p < 0.01) and > 4 cm of bone loss (p < 0.01) but poor correlation with age at injury (p = 0.5), open fracture (p = 0.17), comminuted femoral and/or tibial fracture patterns (p > 0.05) and loss of soft tissue cover (p = 0.08). ConclusionsEarly recognition of clinical modifiers such as high ISS and bone loss > 4 cm warrants targeted limb reconstruction strategy and can help to prognosticate outcome.

Risk Factors for Wound Failure After Primary Closure of Type IIIA Open Tibia Fractures.

The objective of our investigation was to explore risk factors associated with primary closure of type IIIA tibial fractures resulting in subsequent flap coverage. A retrospective study identified 278 patients with acute type IIIA open tibial fractures who underwent primary closure at a single center during an 8-year period. Treatment factors, including the number of debridements before closure, duration of external fixation, and timing of wound closure, were reported. The primary outcome was complication requiring unplanned operation of the study injury resulting in flap coverage. Fifty-five (20%) patients underwent flap coverage following complication after attempted primary closure. Patients who required a flap experienced a 42% complication rate after delayed flap coverage. The limb salvage rate was 95% for the study population. Three significant complication predictors were identified: 3 or more debridements before closure (odds ratio [OR], 29.8; 95% CI, 5.9-150.1; P<.001), wound closure more than 2 days after injury (OR, 9.8; 95% CI, 1.6-60.2; P=.01), and external fixation more than 14 days (OR, 7.3; 95% CI, 1.6-34.6; P=.01). Patients who had 3 or more debridements before closure had a 70.7% chance of having a complication resulting in a flap (29 of 41) compared with only a 6.8% chance of complication for those who had 2 or fewer debridements (14 of 205; P<.001). Risk factors for complication after primary closure of type IIIA open tibial fractures include number of debridements, wound closure after 2 days, and external fixation use for more than 14 days. Wounds requiring 3 or more debridements failed 70.7% after closure, suggesting alternative approaches should be considered in more severe cases. [Orthopedics. 2024;47(2):108-112.].

Where Are We in 2022? A Summary of 11,000 Open Tibia Fractures Over 4 Decades.

To determine the infection and nonunion rates for open tibia fracture treatment over the past 4 decades since the introduction of the Gustilo-Anderson (GA) open fracture classification. PubMed, Scopus, CINAHL, and Cochrane databases were reviewed using the PRISMA checklist for articles between 1977 and September 2018. One hundred sixty-one articles meeting the following inclusion criteria: English language, published between 1977 and 2018, reported infection rates, reported nonunion rates, and fractures classified by the GA open fracture criteria were selected. All articles were thoroughly evaluated to extract infection and nonunion data for open tibia fractures. Due to variability in the data reviewed, statistical evaluation could not be reliably done. 11,326 open tibia fractures were reported with 17% type I, 25.2% type II, 25.3% type IIIA, and 32.5% type IIIB/C. The average infection rate over 4 decades was 18.3%, with 24.3% superficial, 11.2% deep, and 14.7% pin tract. The infection rate by decade was 14% for 1977-1986, 16.2% for 1987-1996, 20.5% for 1997%-2006%, and 18.1% from 2007 to 2017. The overall nonunion rate was 14.1%. The nonunion rate was 13% for 1977-1986, 17% for 1987-1996, 12.8% for 1997%-2006%, and 12.3% for 2007-2017. This in-depth summary has demonstrated that the percentage rate for infections and nonunion has remained similar over the past 40 years. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Trauma

The August 2023 Trauma Roundup360 looks at: A comparison of functional cast and volar-flexion ulnar deviation for dorsally displaced distal radius fractures; Give your stable ankle fractures some AIR!; Early stabilization of rib fractures – an effective thing to do?; Locked plating versus nailing for proximal tibia fractures: A multicentre randomized controlled trial; Time to flap coverage in open tibia fractures; Does tranexamic acid affect the incidence of heterotropic ossification around the elbow?; High BMI – good or bad in surgical fixation of hip fractures?

A deep surgical site infection risk score for patients with open tibial shaft fractures treated with intramedullary nail

ObjectivesTo identify deep infection risk factors in patients with open tibial shaft fractures and to develop a scoring algorithm to predict the baseline deep infection risk in this patient population. MethodsA retrospective cohort study conducted at a single academic trauma center identified patients with open tibial shaft fractures treated with intramedullary nail fixation from December 2006 to October 2020. The primary outcome was a deep surgical site infection requiring surgical debridement. The outcome was identified by Current Procedural Terminology codes and confirmed with a medical chart review documenting evidence of a tibial draining wound or sinus tract. ResultsDeep surgical site infection occurred in 13% of patients (97/769). Factors that predicted deep surgical site infection were identified. Gustilo-Anderson type IIIB or IIIC was the strongest predictor with a 12-fold increase in the odds of deep infection (OR 11.8, p < 0.001). Additional factors included age >40 years (OR 1.7, p = 0.03), American Society of Anesthesiologists score ≥3 (OR 1.9, p < 0.01), Gustilo-Anderson type IIIA vs. type I or II (OR 2.8, p = 0.004), and gunshot wounds (OR 2.9, p = 0.02). The risk scoring model predicted patients who would develop an infection with an acceptable level of accuracy (AUC 0.79). The risk score categorized patients from a low probability of deep infection 2%–6% with <10 points to high risk (58%–69%) with >40 points. ConclusionsThis risk score model predicts deep postoperative infection in patients with open tibial shaft fractures treated with intramedullary nails. The ability to accurately estimate deep infection risk at the time of presentation might aid patient expectation management and allow clinicians to focus infection prevention strategies on the high-risk subset of this population.

External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials.

Tibial shaft fractures are the most common type of long-bone fractures. External fixation (EF) and intramedullary nailing (IMN) are widely used surgical techniques for the definitive fixation of open tibial shaft fractures. The aim of this systematic review and meta-analysis was to compare EF to IMN for the definitive fixation of open tibial fractures. Medline, Embase, and CENTRAL databases were searched for eligible studies. We included randomized controlled trials (RCTs) that compared EF to IMN for skeletally mature adults with open tibial fracture (Gustilo I, II, and III). We evaluated the following outcomes: superficial infection, pin-track infection, deep infection, malunion, nonunion, delayed union, and implant/hardware failure. The risk ratio (RR) was used to represent the desired outcomes. The statistical analysis was performed using the random-effects model. A total of 12 RCTs that enrolled 1090 participants were deemed eligible for the analysis. EF showed a significantly higher rate of superficial infection, pin track infection, and malunion compared to IMN (RR = 2.30, 95% confidence interval (CI): 1.34 to 3.95; RR = 13.52, 95% CI: 6.16 to 29.66; RR = 2.29, 95% CI 1.41 to 3.73, respectively). No substantial difference was found between EF and IMN in terms of deep infection, nonunion, delayed union, or implant/hardware failure (RR = 1.15, 95% CI 0.67 to 1.98; RR = 0.92, 95% CI 0.77 to 1.10; RR = 1.50, 95% CI 0.98 to 3.33; RR = 0.96, 95% CI 0.36 to 2.60, respectively). The findings of our meta-analysis are consistent with the previous systematic reviews excepts for the implant/hardware failure which was found to be significant in favour of IMN by one of the previous reviews. This meta-analysis confirms that IMN is better than EF with respect to clinical outcomes and complication rate for the definitive fixation of open tibial fracture.

Persistent Infection in a Patient with Tibial Non-union

This report presents a case of persistent pin site infection that resulted in the removal of hardware in a patient who underwent Ilizarov stabilization for compound tibial fractures. Despite antibiotics, the infection worsened, necessitating removal of the entire Ilizarov frame to prevent permanent damage or non-union. Bone marrow stimulators were subsequently placed for healing support. The report emphasizes the importance of rigorous pin site care, meticulous monitoring, low threshold for diagnosis of complications and swift escalation of treatment when needed. However, vigilance alone may not be enough, especially in those with co-morbidities, open injuries or hardware applications simplifying opportunities for nosocomial infection. The patient's recovery process involved early, optimized rehabilitation, medical and social supports, leading to a return to partial mobility and function despite a prolonged recovery process. Diligent follow-up was necessary at each stage to recognize complications before permanent damage and revise treatment plans as needed. The report aims to share lessons learned and strengthen preparedness for future cases facing similar challenges. Success emerged from determination, vigilance and partnership. Close monitoring makes the difference between catastrophic loss and maximal benefit from an ordeal already threatened by overcoming disability.

Updated Meta-Analysis of Randomized Controlled Trials Comparing External Fixation to Intramedullary Nailing in the Treatment of Open Tibial Fractures.

Background: The purpose of this study was to collect all available randomized controlled trials (RCT) on the treatment of open tibial fractures with an external fixator (EF) and intramedullary nailing (IMN) for meta-analysis to provide reliable evidence-based data for clinical decision-making. Material and methods: The systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and AMSTAR (Assessing the Methodological Quality of Systematic Review). An electronic search of PubMed, Cochrane Library, and Web of Science was performed until 1 March 2023 to identify RCTs which compared either IMN or EF to fix the open tibial fracture. Outcome measures were: postoperative superficial and deep infection, time to union, delayed union, malunion, nonunion and hardware failure. In addition, pain and health-related quality of life were evaluated after 3 and 12 months of follow-up. Results: Sixteen publications comprising 1011 patients were included in the meta-analysis. The pooled results suggested that the IMN technique had a lower postoperative superficial infection and malunion rate (RR = 3.56, 95%CI = 2.56-4.95 and RR = 1.96, 95%CI = 1.12-3.44, respectively), but higher hardware failure occurrence in contrast to EF (RR = 0.30; 95%CI = 0.13-0.69). No significant differences were found in the union time, delayed union or nonunion rate, and postoperative deep infection rate between the treatments. Lower levels of pain were found in the EF group (RR = 0.05, 95%CI = 0.02-0.17, p < 0.001). A difference in quality of life favoring IMN after 3 months was found (RR = -0.04, 95%CI = -0.05-0.03, p < 0.001), however, no statistical difference was found after 12 months (RR = 0.03, 95%CI = -0.05-0.11, p = 0.44). Conclusions: Meta-analysis presented reduced incidence rates of superficial infection, malunion, and health-related quality of life 3 months after treatment in IMN. However, EF led to a significant reduction in pain and incidence rate of hardware failure. Postoperative deep infection, delayed union, nonunion and health-related quality of life 12 months following therapy were similar between groups. More high-quality RCTs should be conducted to provide reliable evidence-based data for clinical decision-making.

Predictors for infection severity for open tibial fractures: major trauma centre perspective

IntroductionOpen diaphyseal tibial fractures are the most common long-bone fractures and require a rapid approach to prevent devastating complications. Current literature reports the outcomes of open tibial fractures. However, there is no robust, up-to-date research on the predictive indicators of infection severity in a large open tibial fracture patient cohort. This study investigated the predictive factors of superficial infections and osteomyelitis in open tibial fractures.Materials and methodsA retrospective analysis of the tibial fracture database was carried out from 2014 to 2020. Criteria for inclusion was any tibial fracture including tibial plateau, shaft, pilon or ankle, with an open wound at the fracture site. Exclusion criteria included patients with a follow-up period of less than 12 months and who are deceased. A total of 235 patients were included in our study, of which 154 (65.6%), 42 (17.9%), and 39 (16.6%) developed no infection, superficial infection, or osteomyelitis, respectively. Patient demographics, injury characteristics, fracture characteristics, infection status and management details were collected for all patients.ResultsOn multivariate modelling, patients with BMI > 30 (OR = 2.078, 95%CI [1.145–6.317], p = 0.025), Gustilo-Anderson (GA) type III (OR = 6.120, 95%CI [1.995–18.767], p = 0.001), longer time to soft tissue cover (p = 0.006) were more likely to develop a superficial infection, and patients with wound contamination (OR = 3.152, 95%CI [1.079–9.207], p = 0.036), GA-3 (OR = 3.387,95%CI [1.103–10.405], p = 0.026), longer to soft tissue cover (p = 0.007) were more likely to develop osteomyelitis.Univariate analysis also determined that risk factors for superficial infection were: BMI > 35 (OR = 6.107, 95%CI [2.283–16.332], p = 0.003) and wound contamination (OR = 2.249, 95%CI [1.015–5.135], p = 0.047); whilst currently smoking (OR = 2.298, 95%CI [1.087–4.856], p = 0.025), polytrauma (OR = 3.212, 95%CI [1.556–6.629], p = 0.001), longer time to definitive fixation (p = 0.023) were for osteomyelitis. However, none of these reached significance in multivariate analysis.ConclusionHigher GA classification is a significant risk factor for developing superficial infection and osteomyelitis, with a stronger association with osteomyelitis, especially GA 3C fractures. Predictors for superficial infection included BMI and time to soft tissue closure. Time to definitive fixation, time to soft tissue closure, and wound contamination were associated with osteomyelitis.

Does treatment at a level I trauma center reduce disparities in patient outcomes for open tibia fractures? A retrospective analysis of the National trauma Databank

BackgroundRace and insurance status are independent predictors of healthcare outcomes following lower-extremity trauma. Level 1 trauma centers show better outcomes overall, but it is has not been extensively studied as to whether they specifically lower complication rates and shorten length of stay in those with Black race, with low socioeconomic status, and/or a lack of private health insurance. We performed a study with the objective of determining whether Level I trauma centers can improve the complication rate of those shown to be at high risk of experiencing adverse outcomes due to socioeconomic differences. HypothesisLevel 1 trauma centers will be successful in mitigating the disparity in complication rates and length of stay associated with racial and socioeconomic differences among trauma patients experiencing an open tibia fracture. Patients and methodsThe National Trauma Databank was reviewed from 2008 to 2015, identifying 81,855 encounters with an open tibia fracture, and 33,047 at a Level I trauma center. Regression models determined effects of race and insurance status on outcomes by trauma center while controlling for confounders. ResultsBlack race [OR 1.36, 95% CI, 1.17–1.58; p < 0.05] and “other” race [OR 1.28, 95% CI, 1.07–1.52; p < 0.05] were associated with higher odds of injury-specific complications. Patients without private insurance and of non-White or Black race in comparison to White patients had a significantly longer length of stay [coefficient 1.66, 95% CI, 1.37–1.94; p < 0.001]. These differences persisted in patients treated at an American College of Surgeons (ACS) Level I trauma center. DiscussionTreatment at an ACS Level I trauma center did not reduce the independent effects of race and insurance status on outcomes after open tibia fracture, emphasizing the need to recognize this disparity and improve care for at-risk populations.

Relationship between Time to Surgical Debridement and Rate of Wound Infection in Open Tibia Fracture in a Tertiary Care Hospital

Background: The most frequent open long bone injury requiring immediate surgical intervention is an open tibial fracture. Within 6 hours of the injury, emergent surgical debridement of an open tibia fracture is advised by current guidelines. Recently, the 6-hour rule became challenged and delaying in debridement of an open fracture may be unethical. Methods: This cross-sectional study was carried out to assess the relationship between time of surgical debridement and rate of infection after open fracture tibia at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) on 608 patients with open fracture tibia (all Gustilo types) within 24 hours of injury from January 2018 to October 2019. Results: The mean age of the 608 patients was 36.2±15.5 years. The foremost mechanism of injury was road traffic accident (72.0%) and among the associated injuries, concomitant soft tissue injury (32.5%) was prevalent. Gustilo III was predominant injury (72.1%) and infection rates among the Gustilo subtype II was predominant (31.3%). After debridement 73 (12.0%) patients were contamination free. A significant association was found in the contamination rate between surveillance culture and post-debridement culture (p=0.000). Positive correlation found between debridement done ≥6 hours and infection present in 3rd culture from ward (r=0.237). Conclusion: The study insights that injury characteristics, infection pattern and infection rate of open fracture tibia. Delay in debridement has a significant relationship with wound infection, with more virulent multidrug resistance phenotypes.

Epidemiology of Open Tibial Fractures among Trauma Patients Presented to Mansoura Emergency Hospital

Epidemiology of Open Tibial Fractures among Trauma Patients Presented to Mansoura Emergency Hospital