Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Aug 1;35(8):430-436.
doi: 10.1097/BOT.0000000000002033.

Timing of Flap Coverage With Respect to Definitive Fixation in Open Tibia Fractures

Casey Kuripla  1 , Paul Tornetta 3rd  1 , Clary J Foote  2 , Justin Koh  1 , Andrew Sems  3 , Tayseer Shamaa  3 , Heather Vallier  4 , Debra Sorg  4 , Hassan R Mir  5 , Benjamin Streufert  5 , Clay Spitler  6 , Brian Mullis  7 , Brian McGowan  7 , John Weinlein  8 , Lisa Cannada  9 , Jonathan Charlu  9 , Emily Wagstrom  10 , Jerald Westberg  10 , Saam Morshed  11 , Abigail Cortez  11 , Peter Krause  12 , Andrew Marcantonio  13 , Gillian Soles  14 , Jason Lipof  14
Affiliations
Observational Study

Timing of Flap Coverage With Respect to Definitive Fixation in Open Tibia Fractures

Casey Kuripla et al. J Orthop Trauma. .

Abstract

Objectives: We conducted a large, U.S wide, observational study of type III tibial fractures, with the hypothesis that delays between definitive fixation and flap coverage might be a substantial modifiable risk factor associated with nosocomial wound infection.

Design: A retrospective analysis of a multicenter database of open tibial fractures requiring flap coverage.

Setting: Fourteen level-1 trauma centers across the United States.

Patients: Two hundred ninety-six (n = 296) consecutive patients with Gustilo III open tibial fractures requiring flap coverage at 14 trauma centers were retrospectively analyzed from a large orthopaedic trauma registry. We collected demographics and the details of surgical care. We investigated the patient, and treatment factors leading to infection, including the time from various points in care to the time of soft-tissue coverage.

Intervention: Delay definitive fixation and flap coverage in tibial type III fractures.

Main outcome measurements: (1) Results of multivariate regression with time from injury to coverage, debridement to coverage, and definitive fixation to coverage in the model, to determine which delay measurement was most associated with infection. (2) A second multivariate model, including other factors in addition to measures of flap delay, to provide the estimate between delay and infection after adjustment for confounding.

Results: Of 296 adults (227 M: 69 F) with open Gustilo type III tibial fractures requiring flap coverage, 96 (32.4%) became infected. In the multivariate regression, the time from definitive fixation to flap coverage was most predictive of subsequent wound infection (odds ratio 1.04, 95% confidence interval 1.01 to 1.08, n = 260, P = 0.02) among the time measurements. Temporary internal fixation was not associated with an increased risk of infection in both univariate (P = 0.59) or multivariate analyses (P = 0.60). Flap failure was associated with the highest odds of infection (odds ratio 6.83, 95% confidence interval 3.26 to 14.27, P < 0.001).

Conclusion: Orthoplastic teams that are dedicated to severe musculoskeletal trauma, that facilitate coordination of definitive fixation and flap coverage, will reduce the infection rates in Gustilo type III tibial fractures.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest.

References

    1. Davies JI, Meara JG. Global surgery—going beyond the lancet commission. Lancet. 2015;386:507–509.
    1. Meara JG, Greenberg SL. The Lancet Commission on Global Surgery Global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Surgery. 2015;157:834–835.
    1. Meara JG, Hagander L, Leather AJM. Surgery and global health: a lancet commission. Lancet. 2014;383:12–13.
    1. Raykar N, Mukhopadhyay S, Saluja S, et al. Implementation of the lancet commission on global surgery in India. Healthc (Amst). 2019;7:4–6.
    1. Pollak AN, Jones AL, Castillo RC, et al. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg Am. 2010;92:7–15.

Publication types