Factors influencing infection in 10 years of battlefield open tibia fractures

Abstract

The aim of this study was to characterise severe open tibial shaft fractures sustained by the UK military personnel over 10 years of combat in Iraq and Afghanistan. The UK military Joint Theatre Trauma Registry was searched for all such injuries, and clinical records were reviewed for all patients. One hundred Gustilo–Anderson III tibia fractures in 89 patients were identified in the 10 year study period; the majority sustained injuries through explosive weapons (63, 68 %) with the remainder being injured from gunshot wounds. Three fractures were not followed up for 12 months and were therefore excluded. Twenty-two (23 %) of the remaining 97 tibial fractures were complicated by infection, with S. aureus being the causative agent in 13/22 infected fractures (59 %). Neither injury severity, mechanism, the use of an external fixator, the need for vascularised tissue transfer nor smoking status was associated with subsequent infection. Bone loss was significantly associated with subsequent infection (p < 0.0001, Fisher’s exact test). This study presents 10 years of open tibial fractures sustained in Iraq and Afghanistan. Most infection in combat open tibia fractures is caused by familiar organisms, i.e. S. aureus. While the overall severity of a casualty’s injuries was not associated with infection, the degree of bone loss from the fracture was.

Ballistic Trauma-Considerations for the OrthoPlastic Surgical Team

“…The initial aim of orthoplastic surgical management is to create an healthy wound which can eradicate this inevitable bacterial contamination. Infection when it does occur is typically caused by gram-positive staphylococcal species which complicate other traumatic and surgical wounds [9].…”

Virulence of methicillin-resistant Staphylococcus aureus modulated by the YycFG two-component pathway in a rat model of osteomyelitis

“…Osteomyelitis is one type of severe bone infection, and open fractures of long bones are the most frequent etiology [1]. Among the various types of open long bones fractures, tibia fractures have the highest rate of infection due to the lack of soft tissue coverage [2]. The incidence of infection after fracture fixation may be more than 30% in complex open tibia fractures [3].…”

Osteomyelitis Risk Factors Related to Combat Trauma Open Tibia Fractures: A Case–Control Analysis

“…12 Moreover, among wounded United Kingdom (U.K.) military personnel with open tibia fractures, 23% developed deep infections. 14 In civilian cases, patients with open fractures frequently develop infections, 15–19 with severe tibia fractures (Type III) having rates as high as 35%. 20–25 Among combat casualties with Type III open tibia fractures, deep infections, including osteomyelitis, are associated with increased resource utilization stemming from revision surgeries and late amputations (≥12 weeks post-injury).…”