Associations of injury severity with debridement and irrigation practices among patients with open facial fractures

Author(s):
Therese Duane; Erica Sercy; Kaysie Banton; Brian Blackwood; David Hamilton; Andrew Hentzen; Kerrick Akinola; Jeffrey Gordon; David Bar-Or; Matthew Hatch

Background:

Early debridement and irrigation are vital to minimize infection in open fractures. This approach is often delayed in facial fractures because a majority have concurrent, life-threatening injuries and require stabilization before initiation of facial fracture management.

Hypothesis:

Open facial fracture patients with severe injuries are more likely to receive delayed operative management.

Methods:

This was a retrospective study of adult (age ≥18) patients admitted with open facial fracture to six trauma centers in 1/1/2017-3/31/2021. Associations between operative management, including early (≤24h of arrival) versus delayed (>24h) administration, and ISS, type, and extent of facial fractures were investigated.

Results:

This analysis included 161 patients with open facial fracture. Infection occurred in 8 (5%). Almost all (98%) received intravenous antibiotics within 24 hours. Only 21% received at least one debridement, and 89% received at least one irrigation (Table 1). Half (50%) of patients who received debridement had early treatment, and 69% of those who received irrigation had early treatment. Higher ISS was associated with increased likelihood of receiving debridement but not irrigation or early treatment. Higher fracture type (type 3a-c) was associated with increased likelihood of receiving both debridement and irrigation but not early treatment. Patients with more open facial fractures (3+) were more likely to receive debridement but were also more likely to have delayed debridement. Two other measures of injury severity (moderate/severe TBI and ICU admission) were associated with both increased likelihood of undergoing debridement and delayed irrigation.

Conclusions:

This study found that patients received debridement relatively infrequently at the participating trauma centers (21%), although irrigation rates were high (89%). Results showed that more severely injured patients, who are at higher risk for infection, were more likely to be targeted for appropriate fracture management, including receipt of both debridement and irrigation; however, among those who received one or both of these treatment options, those with more severe injuries were at higher risk of delayed treatment. The impact of this delay in treatment on infection rates requires further study to determine optimal coordination of care.