Debridement and wound closure of open fractures: the impact of the time factor on infection rates

Abstract

Open fracture management represents an orthopaedic emergency. Early aggressive management of these debilitating injuries within the first 6h has been encouraged in order to minimise the risk of infection and long term sequelae. Debridement and wash-out of the wound, followed by stabilisation of the bony elements and closure of the soft-tissue envelope are all considered essential. However, the available scientific evidence supporting the timing of this multistage approach of open fracture management, and the "Six-hour rule" itself, are unclear. This review article analyses the available evidence regarding the impact of the timing of wound debridement and closure of open fractures of the lower extremity.