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
Multicenter Study
. 2023 Mar 1;37(3):103-108.
doi: 10.1097/BOT.0000000000002509.

What Is the Safe Window from Definitive Fixation to Flap Coverage in Type 3B Open Tibia Fractures? Supporting Plastics and Orthopaedics Alliance in Reducing Trauma Adverse Events (SPARTA)

Khalid Al-Hourani  1 , Clary J Foote  2 , Andrew D Duckworth  1 , Tim O White  1 , Michael B Kelly  3 , Paul Tornetta 3rd  4 ; SPARTA Investigators
Collaborators, Affiliations
Multicenter Study

What Is the Safe Window from Definitive Fixation to Flap Coverage in Type 3B Open Tibia Fractures? Supporting Plastics and Orthopaedics Alliance in Reducing Trauma Adverse Events (SPARTA)

Khalid Al-Hourani et al. J Orthop Trauma. .

Abstract

Objectives: To delineate whether a "safe" window exists for timing from definitive fixation to definitive soft tissue coverage in the treatment of open tibial diaphyseal fractures requiring flap coverage.

Design: International multicenter, retrospective comparative cohort study.

Patients/participants: Three hundred and seventy-three (n = 373) patients who sustained an open tibial shaft fracture requiring flap coverage.

Methods: We evaluated the deep infection rates based on the timing between the definitive fixation and flap coverage. We determined several intervals of time from the day of definitive fixation (regardless of time from injury) and flap coverage. If performed on the same operative setting these were considered day 0. We evaluated coverage after 2 and 5 days from definitive fixation based on time versus infection rate curve inflection points. We adjusted for time to debridement and antibiotics within an hour.

Main outcome measurement: Deep infection after definitive fixation and flap coverage.

Results: The mean age of the cohort was 42.4 years (SD = 18.2) and 270 were male (72.4%). The deep infection rate after flap coverage was 20.6% (77/373). Definitive fixation to flap coverage time of up to 2 days was not associated with an increased risk of infection [relative risk (RR) = 1.12; 95% confidence interval, 0.92-1.37; P = 0.26]. There was an increased risk of deep infection for more than 2 days (RR = 1.59) and >5 days (RR = 1.64).

Conclusion: This study observed a "safe" window of up to 2 days between definitive fixation and flap coverage in open tibial shaft fractures requiring coverage before a statistical increase in risk of deep infection rate occurred.

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. Costa ML, Achten J, Bruce J, et al. Effect of negative pressure wound therapy vs standard wound management on 12-month disability among adults with severe open fracture of the lower limb: the WOLLF randomized clinical trial. JAMA. 2018;319:2280–2288.
    1. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–458.
    1. Tropet Y, Garbuio P, Obert L, et al. Emergency management of type IIIB open tibial fractures. Br J Plast Surg. 1999;52:462–470.
    1. Khatod M, Botte MJ, Hoyt DB, et al. Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma. 2003;55:949–954.
    1. Lack WD, Karunakar MA, Angerame MR, et al. Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. J Orthop Trauma. 2015;29:1–6.

Publication types