The urgency of surgical débridement in the management of open fractures

Abstract

Emergent débridement of open fractures within 6 hours of injury has long been considered to be critical to prevention of infection. The basis for this mandate is unclear, however. In clinical practice, physiologic and logistical challenges frequently limit the degree to which such emergent surgical care can effectively be rendered. Furthermore, concerns exist that quality of care might be improved when services are performed during normal working hours. The current literature suggests no obvious advantage to performing surgical débridement within 6 hours after injury versus doing so between 6 and 24 hours after injury. The effect of delays >24 hours is unclear. Further research in this area would be helpful, but development of definitive level I evidence seems unlikely. Surgical débridement of open fractures should be accomplished urgently, as soon as the patient's physiologic condition permits and as soon as appropriate resources are available to safely perform the procedure.