1.The Incidence of Fracture-Related Infection in Open Tibia Fracture with Different Time Interval of Initial Debridement
Hadizie D ; Kor YS ; Ghani SA ; Mohamed-Saat MA
Malaysian Orthopaedic Journal 2022;16(No.3):24-29
Introduction: The primary aim of open fracture
management is to prevent fracture-related infection by early
antibiotic administration, debridement and wound coverage.
However, the timing of the initial debridement is still
controversial, and 6 to 24 hours is commonly advocated.
Studies have yet to provide substantial evidence regarding
the best time for surgical debridement. Thus, this study was
conducted to compare the incidence of fracture-related
infection at different time intervals of initial debridement of
the open tibia fracture.
Materials and methods: A total of 91 patients with grade I,
II and IIIa open tibia fractures were recruited from 2016 to
2018, and their data were obtained from the consensus book
and medical records. Participants were divided into four
groups based on the time of initial debridement: (1) less than
6 hours, (2) 6 to less than 12 hours, (3) 12 to less than 24
hours, and (4) 24 hours and more. Fracture-related infection
was determined by using Metsemakers confirmative criteria.
Association between time and infection were determine by
Binary Logistic Regression analysis by remerged the group
into three; (1) less than 12 hours, (2) 12 to less than 24 hours
and (3) 24 hours and more. The collected information was
analysed using SPSS version 24 and Microsoft Excel 2010.
Results: The mean age of the participants was 31.9 years
old, with male predominant (n=80, 87.0%). Most
participants had delayed initial debridement of more than 24
hours and predominantly Gustilo-Anderson type IIIa (n=47).
A total of 8 fractures complicated with infection (8.7%),
majority in grade IIIa and debridement performed within 12
to less than 24 hours. Binary logistic regression showed
increased odds of infection with a delayed wound
debridement both in clinical presentation and positive
culture, but the association was not statistically significant.
The commonest organism isolated was Pseudomonas
aeruginosa.
Conclusion: Comparing to different time interval, initial
wound debridement of more than 24 hours did not have
strong association with increasing infection rate. However,
even though statistically not significant, the odds of infection
was increase with increasing time of initial wound
debridement of an open tibia fracture, thus it should be
performed early.