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. 2021 Nov 27:24:101715.
doi: 10.1016/j.jcot.2021.101715. eCollection 2022 Jan.

Definitive fixation of open tibia fractures: Does reopening the traumatic wound increase complication rates?

Alan W Reynolds  1 , Mariano Garay  1 , Frances Hite Philp  1 , Jon E Hammarstedt  1 , Gregory T Altman  1 , Chima D Nwankwo  2
Affiliations

Definitive fixation of open tibia fractures: Does reopening the traumatic wound increase complication rates?

Alan W Reynolds et al. J Clin Orthop Trauma. .

Abstract

Background: It is unknown if surgical approach or use of previous traumatic wounds for open fracture instrumentation has an impact on patient complications or outcomes. This study sought to compare infection and nonunion rates in the staged treatment of open tibia fractures where the traumatic wound was reopened during definitive fixation versus when they were not.

Methods: A retrospective review was performed on all patients at a single institution level 1 trauma center. All patients who had a minimum of 1 year clinical and radiographic outcomes were included. Primary outcome measures were incidence of infection and nonunion. Groups of patients were compared based on surgical approach for definitive fixation.

Results: A total of 96 patients were included - 48 patients received definitive treatment and wound closure during initial management of the open fracture (group 1), 22 patients had staged fixation through new incisions (group 2), and 26 patients had their traumatic wound reopened during definitive fixation (group 3). Rates of infection were 10.4%, 31.8% and 11.5% respectively (p = 0.15). Rates of nonunion were 20.8%, 27.3% and 30.8% (p = 1.0). No statistically significant differences in regards to primary outcomes were found between the staged fixation groups. Multiple logistic regression also showed no difference in infection or nonunion when controlling for known risk factors.

Conclusion: For open tibia fractures that underwent staged fixation, no significant differences in infection or nonunion were observed between procedures that involved reopening the traumatic wound versus procedures performed through new incisions. The presence of a distal tibia periarticular fracture was found to be independently associated with infection risk.

Keywords: Delayed fixation; Infection; Open fracture; Tibia.

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References

    1. Hannigan G.D., Pulos N., Grice E.A., Mehta S. Current concepts and ongoing research in the prevention and treatment of open fracture infections. Adv Wound Care. 2015;4(1):59–74. doi: 10.1089/wound.2014.0531. - DOI - PMC - PubMed
    1. Southam B.R., Archdeacon M.T. “Iatrogenic” segmental defect: how I debride high-energy open tibial fractures. J Orthop Trauma. 2017;31(Suppl 5):S9–S15. doi: 10.1097/BOT.0000000000000984. - DOI - PubMed
    1. Gristina A.G., Costerton J.W. Bacterial adherence to biomaterials and tissue. The significance of its role in clinical sepsis. J Bone Joint Surg Am. 1985;67(2):264–273. - PubMed
    1. Schenker M.L., Yannascoli S., Baldwin K.D., Ahn J., Mehta S. Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Joint Surg Am. 2012;94(12):1057–1064. doi: 10.2106/JBJS.K.00582. - DOI - PubMed
    1. Sirkin M., Sanders R., DiPasquale T., Herscovici D. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 2004;18(8 Suppl):S32–S38. doi: 10.1097/00005131-200409001-00005. - DOI - PubMed

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