Management of Open Tibial Shaft Fractures: Does the Timing of Surgery Affect Outcomes?

Duyos, Oscar A; Beaton-Comulada, David; Dávila-Parrilla, Ariel; Pérez-López, José C; Ortiz, Krystal; Foy-Parrilla, Christian; Lopez-Gonzalez, Francisco

doi:10.5435/jaaos-d-16-00127

Cited by 31 publications

(17 citation statements)

References 19 publications

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“…45 While not significant as a risk factor in the meta-analysis, 39 external fixation has been associated with higher infection rates with GA-I and GA-II fractures, while it decreased likelihood of infections with GA-III fractures. 46 GA-III fractures comprised 84% of our population (excluding TTA) and while use of any external fixation was not significantly different between cases and controls (85% versus 78%, respectively), more cases did have external fixation as their last orthopedic hardware (68% versus 33%; p<0.001). The timing of wound closure has also been examined with occurrence of closure >5 days post-injury being identified as an infection risk factor with open tibia fractures.…”

Section: Discussionmentioning

confidence: 78%

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

Tribble

Lewandowski

Potter

et al. 2018

Journal of Orthopaedic Trauma

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Section: Discussionmentioning

confidence: 78%

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

Tribble

Lewandowski

Potter

et al. 2018

Journal of Orthopaedic Trauma

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“…Most guidelines recommend 24 hours of antibiotics following type I and II Gustillo fractures. 5 Patzakis and Wilkins found no additional benefit on the risk of infection prolonging the duration of antibiotics beyond 3 days. 12 Extension of this period for 48h postoperatively is a safe and effective prophylactic option, so it was decided to complete 48 hours of antibiotic.…”

Section: Discussionmentioning

confidence: 98%

“…Generally speaking, the management of an open tibial fracture requires prompt history and physical examination, systemic antibiotics, local debridement and irrigation, temporary or definitive fixation, and less frequently, soft-tissue coverage and/or vascular repair. 5,6 Potentially life-threatening injuries were ruled out on a primary detailed evaluation. This patient presented an open fracture, Gustillo-Anderson type II (9 cm wound).…”

Section: Discussionmentioning

confidence: 99%

“…6 Systemic antibiotic prophylaxis (Cephalosporin) was initiated within 3 hours after trauma, in accordance with current scientific evidence to prevent Gram-positive infection. 5 Although combined grampositive and gram-negative coverage for these less-severe open fractures has been proposed by other investigators, it is not widely used. 7 A debridement with antiseptic and sodium chloride solution was then performed in the emergency room.…”

Section: Discussionmentioning

confidence: 99%

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Can an open displaced tibial fracture be treated without surgery? a treatment discussion: a case report

2021

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<p class="abstract">The authors present a case of a 70-year-old female with left tibial open fracture (Gustillo-Anderson type II) with previous history of trauma of the same limb, from which resulted a Morel-Lavallée injury complicated with extensive tissue necrosis. Considering the sequel condition of soft tissues (scarring and extensive fibrosis), conservative treatment was taken and successful result was achieved. In this case the biggest concern was not the traumatic tissue damage caused by the fall, but the poor quality of tissues already existent before this event. Although surgical treatment is the gold standard in these cases, we must analyze case by case the risk benefit of each procedure and choose the one we believe is the best for the patient.</p>

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“…Bednar and Parikh [27] and Duyos et al [40] did not provide raw data on the number of tibial fractures infected or debrided within each time group and, thus, were not included in the meta-analysis. However, they reported no statistically significant difference in infection rate between early and late debridement groups.…”

Section: Infectionmentioning

confidence: 99%

The Effect of Delayed Surgical Debridement in the Management of Open Tibial Fractures: A Systematic Review and Meta-Analysis

et al. 2021

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Introduction: Open tibial fractures are complex injuries with variable outcomes that significantly impact patients’ lives. Surgical debridement is paramount in preventing detrimental complications such as infection and non-union; however, the exact timing of debridement remains a topic of great controversy. The aim of this study is to evaluate the association between timing of surgical debridement and outcomes such as infection and non-union in open tibial fractures. Materials and Methods: We performed a systematic review and meta-analysis of the literature to capture studies evaluating the association between timing of initial surgical debridement and infection or non-union, or other reported outcomes. We searched the MEDLINE, PubMed Central, EMBASE, SCOPUS, Cochrane Central and Web of Science electronic databases. Our methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane handbook for systematic reviews of interventions. Results: The systematic review included 20 studies with 10,032 open tibial fractures. The overall infection rate was 14.3% (314 out of 2193) and the overall non-union rate 14.2% (116 out of 817). We did not find any statistically significant association between delayed debridement and infection rate (OR = 0.87; 95% CI, 0.68 to 1.11; p = 0.23) or non-union rate (OR = 0.70; 95% CI, 0.42 to 1.15; p = 0.13). These findings did not change when we accounted for the effect of different time thresholds used for defining early and late debridement, nor with the Gustilo–Anderson classification or varying study characteristics. Conclusion: The findings of this meta-analysis support that delayed surgical debridement does not increase the infection or non-union rates in open tibial fracture injuries. Consequently, we propose that a reasonable delay in the initial debridement is acceptable to ensure that optimal management conditions are in place, such that the availability of surgical expertise, skilled staff and equipment are prioritised over getting to surgery rapidly. We recommend changing the standard guidance around timing for performing surgical debridement to ‘as soon as reasonably possible, once appropriate personnel and equipment are available; ideally within 24-h’.

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Management of Open Tibial Shaft Fractures: Does the Timing of Surgery Affect Outcomes?

Abstract: Level III retrospective study.

Cited by 31 publications

References 19 publications

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

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

Can an open displaced tibial fracture be treated without surgery? a treatment discussion: a case report

The Effect of Delayed Surgical Debridement in the Management of Open Tibial Fractures: A Systematic Review and Meta-Analysis

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