Factors influencing infection rates after open fractures of the radius and/or ulna.

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.