Impact Of timing of Debridement Of Open Long Bone Fractures In The Lower Extremities in Blunt Trauma On Wound Infection

Author(s):
Nasim Ahmed; Patricia Greenberg

Background:

The purpose of this study was to see the impact of the timing of incision and debridement ( I & D) for cases of open femur, tibia, and fibula fractures following a blunt injury on the occurrence of surgical site infections (SSI), wound disruption, and sepsis.

Hypothesis:

early I & D of open long bone fracture decreases surgical site infections

Methods:

Patients from the National Trauma Data Bank (2007-2010) who sustained blunt injuries and were diagnosed with an open femur, tibia, or fibula fracture and also underwent an I & D within 24 hours of arrival to the hospital were eligible for inclusion in the study. The patients’ characteristics and outcomes were compared between two groups: I & D within 8 hours (Group 1) and between 8-24 hours (Group 2). Initial patient measures and outcomes were compared between the two unmatched groups However, to better balance the groups at baseline, propensity score matching was performed and a follow-up paired analysis was done.

Results:

A total of 9,798 patients qualified for the study and of those, 8,292 (84.6 %) patients underwent an I & D within 8 hours (Group 1) and 1,506 (15.4%) underwent an I & D between 8-24 hours after arrival (Group 2). There were significant baseline differences between the two groups regarding age (P=0.03), race (white vs. nonwhite, P<0.001), Injury severity score (ISS, P<0.001), Glasgow Coma Scale (GCS, P<0.001) and the number of patients with an initial systolic blood pressure (iSBP) < 90 mmHg (P=0.03). Given these clear differences, 1,495 patients from each group were pair-matched using age, sex, race, mechanism of injury, ISS, GCS, and iSBP. Afterward, there were no significant differences observed between the two groups in these matching variables. There were also no significant differences observed in the occurrence of sepsis (2.2 % vs 2.7%, P=0. 51), superficial SSI (1.0% vs. 1.5%, P=1.0), deep SSI (0.2% vs. 0.4%, P= 0.68), wound disruption (0.6% vs. 0.8%, P=1.0), or hospital length of stay (Median [IQR]: 8.0 [4.0, 16.0] vs. 8.0[4.0, 16.0], P=0.62) between Group 1 and Group 2, respectively. However, a higher number of patients went home without any services in Group 2 compared to Group 1 (57.5% vs. 52.4%, P=0.005).

Conclusions:

There were no significant differences identified between the groups regarding superficial SSI, deep SSI, wound disruption, and sepsis rates, or median hospital length of stay. Conversely, a significantly higher proportion of patients who had the I & D later went home without any follow-up services needed.