Infection Rates in Open Fractures of the Tibia: Is the 6-Hour Rule Fact or Fiction?

Kamat, Ameya S.

doi:10.4061/2011/943495

Cited by 30 publications

(35 citation statements)

References 10 publications

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“…36 However, the traditional 'six hour rule' has been challenged in recent literature. 11,37 Originally described by Friedrich in 1898, multiple studies have shown that this narrow time window should not be followed rigidly. 38,39 In our local hospitals, the demand for emergency theatre time does not permit surgery in the first six hours due to the high trauma burden and relative staff shortages.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of intramedullary nailing for open fractures of the tibial shaft

Seron¹,

Rasool

2018

SA orthop. j.

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Aim: To establish superficial and deep infection rates and time to union of open tibial shaft fractures treated with primary debridement and locked intramedullary nails. Materials and methods:The clinical records and radiographs were retrospectively reviewed of 74 Gustilo-Anderson grades 1 to 3A open tibial shaft fractures that were treated by initial debridement and intramedullary nail fixation over a two-year period. Sixty-three men and nine women with a mean age of 33 years (range 16-67) were followed up for a mean period of 18 months (range 7-32).Results: Sixteen patients (22%) sustained grade 1 injuries, 38 (51%) grade 2, and 20 (27%) had grade 3A injuries. Thirteen patients (18.1%) were HIV positive. The mean time to surgery was 28 hours (range 8-112). The overall infection rate was 17.6%. Superficial infection developed in 10.8% and deep infection occurred in 6.8%. There was no association between time to surgery and infection rate (p=0.878). There was no association between HIV status and infection (p=0.471). There was no association between type of closure and sepsis (p=0.410). The mean time to union was 17 weeks (range 12-50). Five patients (6.9%) had delayed union and one patient failed to unite without undergoing secondary procedures. Conclusion:The management of Gustilo-Anderson grade 1 to 3A open tibial shaft fractures with primary debridement and locked intramedullary nailing shows good short-term results with low infection and non-union rates despite delay in surgical management or HIV infection. Level of evidence: Level 4Key words: open tibial fractures, intramedullary nails, infection, union

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Section: Discussionmentioning

confidence: 99%

Outcomes of intramedullary nailing for open fractures of the tibial shaft

Seron¹,

Rasool

2018

SA orthop. j.

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“…However, studies showed that there is no significant statistical difference between open fractures operated before or after the 6 th hour time and the occurrence of infection [14] [17]- [19]. Surgeon's experience plays no role on the occurrence of an infection after nailing.…”

Section: Resultsmentioning

confidence: 99%

“…Variation of rates could be explained by timing of surgery, and more imprtantly the regularity of antibiotherapy and working conditions [15] [19]. It is important that patients meet the cost of their antibiotics from admission to healing.…”

Section: Staphylococcus Aureusmentioning

confidence: 99%

Intramedullary Nailing of Type I and Type II Open Leg Fractures after 6 Hours at Yopougon Teaching Hospital

Traoré¹,

Slim²,

Niaoré³

et al. 2016

OJO

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Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. In developing countries, patients are admitted to teaching hospitals 6 to 24 hours after their initial trauma. We sought to evaluate outcomes of nailing and correlations between the risk of infection and the delay in surgery. Materials and methods: Medical files of 48 men and 15 women with a combined total of 63 open fractures of the leg during a 12-year period were reviewed. The mean age was 29 years. Thirty-four type I and 29 type II open fractures according to the classification of Cauchoix and Duparc were treated with Küntscher nail after excision/debridement. Preoperative CRP was performed in 27 patients and in 22 cases it was positive. Twenty-six fractures were treated within a period of 6 to 24 hours, and a further 37 was operated on beyond 24 hours. The average waiting time before surgery was 2 days. Results: The infection was present in 11 patients (17.5%). We failed to establish any correlation between the time of treatment and the occurrence of infection for both type I and type II fractures treated during the same intervals with p = 0.244 (p > 0.05). But we established a correlation between the type of open fracture and the occurrence of infection with p = 0.01 (p < 0.05). There were 10 cases of infection among 22 cases of positive preoperative CRP. We couldn't find a correlation between the positive value of the pre-operative CRP and the occurrence of infection. Seven cases of infection were treated with appropriate antibiotherapy and early revision surgery. Four others cases complicated to bone infection (n = 2) and septic nonunion (n = 2). The average time of hospitalization was 22 days. The average time for fracture healing was 7 months. Conclusion: The rule of six hours is hardly applicable in our contexts. Our study showed no correlation between the preoperative period and the occurrence of infection.

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“…Kamat et al [21] found an infection rate of 11.6 %, Singh et al [22] found 14.9 %, and Spencer et al [9] showed 14.6 % cases of infection. These reports slightly differ from the present paper.…”

Section: Discussionmentioning

confidence: 99%

“…These reports slightly differ from the present paper. In the study by Kamat et al [21] there were only 21.3 % of Gustilo type III fractures and all the cases were operated within a period of less than 17 h, 93 % of the Gustilo type III patients (49.5 %) in the study by Spencer et al [9] were treated within 12 h of the injury, and 69 % of the type III fractures were treated within 6 h in the report by Singh et al [22]. …”

Section: Discussionmentioning

confidence: 99%

Predisposing factors for early infection in patients with open fractures and proposal for a risk score

Matos

Lima

Oliveira

2015

J Orthopaed Traumatol

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BackgroundThe primary goals of orthopedic treatment of open fractures are to prevent infection, stabilize bone injury and restore limb function. The objective of the current study was to identify risk factors associated with infection in patients suffering from open fractures, using the strength of association of these factors to propose a score that enables risk stratification in initial care.Materials and methodsA retrospective analysis was performed on 122 patients who underwent open fracture treatment. Clinical and demographic data were collected and the results were divided into two groups: those without infection and those with infection. Both groups were evaluated searching for associated factors that could lead to infection.ResultsThirty-one patients out of 122 were infected (25.4 %). Infection was significantly associated with exposure time up to 24 h (mean 30.3 h; p = 0.007). Fractures classified as Gustilo III had a greater chance of infection (74.2 %; p = 0.042), especially type IIIB (41.9 %). Fractures classified as Tscherne II and III had a greater chance of infection (48.4 and 25.8 %, respectively; p = 0.001).ConclusionsIt was possible to show that the exposure time and the types of fracture classified as Gustilo III and Tscherne II and III are associated with the outcome of infection. It was also possible to create a risk score (IRS) for predicting infection in these types of fractures, which can be used in the initial care of the patient, with a sensitivity of 0.840, specificity of 0.544, cut-off of 6.5 and area under the curve of 0.709 (p = 0.002).Level of evidenceLevel III.

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Infection Rates in Open Fractures of the Tibia: Is the 6-Hour Rule Fact or Fiction?

Cited by 30 publications

References 10 publications

Outcomes of intramedullary nailing for open fractures of the tibial shaft

Outcomes of intramedullary nailing for open fractures of the tibial shaft

Intramedullary Nailing of Type I and Type II Open Leg Fractures after 6 Hours at Yopougon Teaching Hospital

Predisposing factors for early infection in patients with open fractures and proposal for a risk score

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