The Gustilo–Anderson classification system as predictor of nonunion and infection in open tibia fractures

Thakore, Rachel V.; Francois, Elvis L.; Nwosu, Samuel K.; Attum, Basem; Whiting, Paul S.; Siuta, Michael; Benvenuti, Michael A.; Smith, A. K.; Shen, Michelle; Mousavi, Idine; Obremskey, William T.; Sethi, Manish K.

doi:10.1007/s00068-016-0725-y

Cited by 61 publications

(52 citation statements)

References 32 publications

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“…This trend is further supported in the literature. A recent study created a multivariate model to evaluate the influence of several factors on infection rates and Gustilo type was found to be the greatest predictor of nonunion and infection [13] . This suggests that management of open tibia fractures should be guided by Gustilo type rather than time from injury [13] .…”

Section: Resultsmentioning

confidence: 99%

“…A recent study created a multivariate model to evaluate the influence of several factors on infection rates and Gustilo type was found to be the greatest predictor of nonunion and infection [13] . This suggests that management of open tibia fractures should be guided by Gustilo type rather than time from injury [13] . Our trend did not show statistical significance, possibly because the limitations of our study, which may have hidden an association between Gustilo type and infection.…”

Section: Resultsmentioning

confidence: 99%

“…Treatment protocols advocate for expedient surgical debridement and IV antibiotics to reduce the risk of infection. However, over time, a "six-hour rule" seems to have evolved based mainly on historical tradition rather than scientific evidence [1,5,6,[9][10][11][12][13] .…”

Section: Discussionmentioning

confidence: 99%

“…Over time, an unwritten "six-hour rule" has developed within the orthopaedic community; it is widely advocated that initiating treatment within six hours of injury reduces the rate of morbidity and mortality [6][7][8][9] . While the literature agrees that urgent care is essential, there is little scientific evidence to support this "sixhour rule" [1,5,6,[9][10][11][12][13] .…”

Section: The Effect Of Treatment Delay On Infection In Open Tibia Framentioning

confidence: 99%

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The Effect of Treatment Delay on Infection in Open Tibia Fractures: A Retrospective Study in Ethiopia

Kantor

Gallagher

Rosario

et al. 2019

International Journal of Orthopaedics

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BACKGROUND: Infection is a devastating complication of open fractures. Historically, treatment protocols advocated that initial treatment of open fractures within six hours reduced the risk of infection. Little scientific evidence has supported this "six-hour rule" but the exact time in which the risk of infection increases remains unknown. AIM: Assess the effect of delay in treatment greater than 6 and 24 hours on the development of infection for open tibia fractures. METHODS: A retrospective review of all patients was conducted to identify skeletally mature patients with an open tibia fracture treated with the Surgical Implant Generation Network (SIGN) intramedullary nail from February 2006 and June 2015. Descriptive data, time to treatment, fracture characteristics, and presence of infection were collected and analyzed. RESULTS: Infection occurred in 19 (11%) patients (Gustilo I 1/44, 2%; Gustilo II 6/39, 15%, Gustilo IIIa 9/44, 21%; Gustillo IIIb 3/44, 7%). Sixty patients received treatment within six hours of their injury, while 93 did not. One hundred forty-four patients were treated within 24 hours from injury (mean, 8.2 hours) and 28 were treated after 24 hours (mean, 41.1 hours). There was no significant difference in the rates of infection for fractures treated before or after six hours from the time of injury (15% vs. 11%, p = 0.621). Infection rate was similar in patients treated within 24 hours and beyond 24 hours (10% vs. 14%, p = 0.518). The average time to treatment of patients with and without infectious outcome were not significantly different (15.6 vs 13.4 hours, p = 0.700). There was an association between more severe Gustilo types and infection, yet this did not reach significance (p = 0.402). CONCLUSION: Our results show that initial treatment beyond 24 hours did not lead to a significant increase in the rate of infection. While not significant, a greater proportion of infections occurred in higher Gustilo types. Our results suggest that fracture type rather than time to treatment may be a more important predictor of infection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: The Effect Of Treatment Delay On Infection In Open Tibia Framentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Treatment Delay on Infection in Open Tibia Fractures: A Retrospective Study in Ethiopia

Kantor

Gallagher

Rosario

et al. 2019

International Journal of Orthopaedics

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“…1 In the later stages, Gustilo IIIC open comminuted fractures are prone to serious complications such as limb blood supply disorders, bone nonunion and infection, and amputation. [2][3][4] The rapid development of microsurgical techniques has provided better treatment options for Gustilo IIIC open fractures. 5 Gustilo et al 3 reported that the infection rate was as high as 42% for Gustilo IIIC fractures.…”

Section: Introductionmentioning

confidence: 99%

Masquelet technique combined with microsurgical technique for treatment of Gustilo IIIC open distal tibial fractures: a retrospective single-center cohort study

Wang

Tang

et al. 2020

J Int Med Res

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Objective: This study was performed to investigate the clinical effects of the Masquelet technique combined with a microsurgical technique for treatment of Gustilo IIIC open distal tibial fractures. Methods: Fifteen patients with a mean age of 39.3 AE 7.9 years (range, 21-43 years) with Gustilo IIIC open distal tibial fractures were treated by the Masquelet technique combined with a microsurgical technique from May 2013 to January 2017. The mean length of the bone defect was 6.9 AE 2.2 cm (range, 5.2-10.7 cm). The mean area of the wound defect was 129.3 AE 41.4 cm 2 (range, 83.7-180 cm 2 ). Complications and fracture healing were recorded. At the last follow-up, the functional outcome was measured using the Iowa ankle score. Results: All 15 patients achieved bone healing, and the median healing time was about 6.1 months (range, 5-8 months). No complications such as infection or nonunion occurred. At the last follow-up, the median Iowa ankle score was 82 (range, 68-88). The rate of an excellent and good Iowa ankle score was 86.6%. Conclusions: Application of the Masquelet technique combined with a microsurgical technique is an effective strategy for the treatment of Gustilo IIIC open distal tibial fractures.

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Complications in Orthopedic Trauma Surgery: Fracture-Related Infection

Burch

Moriarty

Kuehl

et al. 2020

Racing for the Surface

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The Gustilo–Anderson classification system as predictor of nonunion and infection in open tibia fractures

Abstract: Our study found that the Gustilo grade of open tibia fracture is by far the greatest predictor of nonunion and infection.

Cited by 61 publications

References 32 publications

The Effect of Treatment Delay on Infection in Open Tibia Fractures: A Retrospective Study in Ethiopia

The Effect of Treatment Delay on Infection in Open Tibia Fractures: A Retrospective Study in Ethiopia

Masquelet technique combined with microsurgical technique for treatment of Gustilo IIIC open distal tibial fractures: a retrospective single-center cohort study

Complications in Orthopedic Trauma Surgery: Fracture-Related Infection

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