The Journal of hand surgery · 2014
Factors influencing infection rates after open fractures of the radius and/or ulna.
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Zumsteg Justin W, Molina Cesar S, Lee Donald H, Pappas Nick D
Аннотация
PURPOSE: To investigate factors associated with the development of deep infection in patients with open fractures of the radius and/or ulna.
METHODS: We retrospectively reviewed 296 open fractures of the radius and/or ulna. Of these patients, 200 had at least 6-month follow-up and were included in this study. The following variables were examined for each patient: time from injury to antibiotic administration, time from injury to operative debridement, Gustilo-Anderson classification, type of antibiotic received, and host characteristics such as age, diabetes, and tobacco use. Outcome parameters included the presence of deep infection and fracture union.
RESULTS: The overall rate of deep infection was 5% (10 of 200). No type 1 fractures (of 41) developed deep infection. In contrast, 4% (2 of 48) of type 2 and 7% (8 of 110) of type 3 fractures developed infection. Of 200 patients, 28 received antibiotics in less than 3 hours and underwent debridement in less than 6 hours from the time of injury; however, they did not have lower rates of infection. Similar findings were noted when nonunion was used as the outcome, and the association between Gustilo-Anderson classification and the development of nonunion was statistically significant.
CONCLUSIONS: Factors such as time to antibiotics and time to operative debridement were not predictors for either rate of deep infection or nonunion in open fractures of the radius and/or ulna. The type of fracture as outlined by the Gustilo-Anderson classification was the factor most strongly associated with the development of deep infection and nonunion in these fractures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
METHODS: We retrospectively reviewed 296 open fractures of the radius and/or ulna. Of these patients, 200 had at least 6-month follow-up and were included in this study. The following variables were examined for each patient: time from injury to antibiotic administration, time from injury to operative debridement, Gustilo-Anderson classification, type of antibiotic received, and host characteristics such as age, diabetes, and tobacco use. Outcome parameters included the presence of deep infection and fracture union.
RESULTS: The overall rate of deep infection was 5% (10 of 200). No type 1 fractures (of 41) developed deep infection. In contrast, 4% (2 of 48) of type 2 and 7% (8 of 110) of type 3 fractures developed infection. Of 200 patients, 28 received antibiotics in less than 3 hours and underwent debridement in less than 6 hours from the time of injury; however, they did not have lower rates of infection. Similar findings were noted when nonunion was used as the outcome, and the association between Gustilo-Anderson classification and the development of nonunion was statistically significant.
CONCLUSIONS: Factors such as time to antibiotics and time to operative debridement were not predictors for either rate of deep infection or nonunion in open fractures of the radius and/or ulna. The type of fracture as outlined by the Gustilo-Anderson classification was the factor most strongly associated with the development of deep infection and nonunion in these fractures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.