Effect of Time Delay from Injury to Primary Management on the Incidence of Deep Infection After Open Fractures of the Lower Extremities Caused by Blunt Trauma in Adults

Bednar, Drew A.; Parikh, Jay

doi:10.1097/00005131-199312000-00008

Cited by 106 publications

(44 citation statements)

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“…The length of hospital stay was also slightly more in the late group compared to the early group, although the difference was not statistically significant. In the light of these findings on the outcomes; both groups deserves equal attention so as to reduce financial and other logistical implications related to SSI and longer LOS [32]. …”

Section: Discussionmentioning

confidence: 99%

The effect of early versus delayed surgical debridement on the outcome of open long bone fractures at Bugando Medical Centre, Mwanza, Tanzania

Nobert

Moremi

Seni

et al. 2016

J Trauma Manage Outcomes

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BackgroundUrgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection. Due to limited information on the timing of this surgical procedure in Mwanza, Tanzania; the present study was conducted to evaluate the effect of early versus delayed surgical debridement on the outcome of open long bone fractures.MethodsA prospective cohort study involving 143 patients with open long bone fractures admitted at Bugando Medical Centre (BMC) between December 2014 and April 2015 was conducted. Patients were stratified into two main groups basing on whether they presented at BMC and operated early (within 6 h) or late (more than 6 h). Socio-demographic and clinical information were collected using structured questionnaire. Analysis was done using STATA software version 11.ResultsThe male to female ratio was 1.6: 1, with most of the patients being in their third decade of life (30.8 %). Road traffic accident (RTA) was the most common cause of fractures (67.8 %). Majority of patients, 91 (63.6 %) had Gustillo-Anderson grade II and the timing of debridement was significantly associated with this grading (p-value = 0.05). Nine (6.3 %) patients developed surgical site infection (SSI) and the median length of hospital stay (LOS) (interquartile range) was 7 (5–10) days, ranging from 3 to 35 days. SSI was found more in the late group compared to the early group [7.5 % (6/80) versus 4.8 % (3/63) respectively, p-value = 0.503)] and LOS was also longer in the late group compared to the early group [7 (6–11.5) days and 6 (5–10) days respectively, p-value = 0.06]. Pseudomonas aeruginosa was the predominant bacteria causing SSI.ConclusionsOpen long bone fracture injuries due to RTA are common at BMC. The risk of developing SSI in this setting is low and comparable to many other countries. Despite the fact that there was no statistical significant difference between early versus delayed debrided groups on SSI and LOS stays; the need for prompt surgical intervention in both groups should be an enduring focus to maintain these favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

The effect of early versus delayed surgical debridement on the outcome of open long bone fractures at Bugando Medical Centre, Mwanza, Tanzania

Nobert

Moremi

Seni

et al. 2016

J Trauma Manage Outcomes

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“…3,4,8 Although much has been written on the management of open fractures, there is little evidence to support the need for emergency surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

The effect of time delay on infection in open long-bone fractures: a 5-year prospective audit from a district general hospital

Spencer

Smith²,

Woods³

2004

Ann R Coll Surg Engl

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“…In 1993, Bednar et al analyzed retrospectively the effects of delayed management of 82 open, mostly low-grade (Gustilo I, II, or IIIa) lower-extremity fractures [80]. All patients received cefazolin, and an aminoglycoside was added for IIIb/IIIc fractures.…”

Section: Retrospective Non-randomized (Class Iii) Studiesmentioning

confidence: 99%

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

Hauser

Adams

Eachempati

2006

Surgical Infections

217

116

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The data support the conclusion that a short course of first-generation cephalosporins, begun as soon as possible after injury, significantly lowers the risk of infection when used in combination with prompt, modern orthopedic fracture wound management. There is insufficient evidence to support other common management practices, such as prolonged courses or repeated short courses of antibiotics, the use of antibiotic coverage extending to gram-negative bacilli or clostridial species, or the use of local antibiotic therapies such as beads. Large, randomized, blinded trials are needed to prove or disprove the value of these traditional approaches. Such trials should be performed in patients with high-grade fractures who (1) are well-stratified according to the degree of local injury and (2) undergo standardized fracture and wound management. Trials also must be powered to study the effects of extended antibiotic coverage on nosocomial infections. Antibiotic regimens confirmed to improve local fracture outcomes in such studies could then be used rationally, balancing the risks of local fracture-related infections and of multi-drug-resistant systemic infections to achieve optimal global outcomes.

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Effect of Time Delay from Injury to Primary Management on the Incidence of Deep Infection After Open Fractures of the Lower Extremities Caused by Blunt Trauma in Adults

Cited by 106 publications

References 0 publications

The effect of early versus delayed surgical debridement on the outcome of open long bone fractures at Bugando Medical Centre, Mwanza, Tanzania

The effect of early versus delayed surgical debridement on the outcome of open long bone fractures at Bugando Medical Centre, Mwanza, Tanzania

The effect of time delay on infection in open long-bone fractures: a 5-year prospective audit from a district general hospital

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

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