THE RELATIONSHIP BETWEEN TIME TO SURGICAL DEBRIDEMENT AND INCIDENCE OF INFECTION IN GRADE III OPEN FRACTURES.

Introduction The policy of treating open fractures within 6 hrs can result in complex operations being performed under sub optimal conditions. The purpose of this study was to determine the association between time to initial debridement and rate of infection in high energy (Grade III) open fractures of Tibia. Methods Medical records of all patients presenting with open fractures were reviewed. The inclusion criterion were Gustillo III A, B and C open fractures of tibia. Time of injury, time of arrival to the hospital, time of initial debridement and subsequent soft tissue procedures were recorded. The primary outcome measure was a diagnosis of infection or osteomyelitis at one year. Secondary outcome measure was fracture union at one year. Results 67 patients with grade III open fractures were included, mean age was 32.4 years (54 males and 13 females). Eight patients (12%) in this study went onto develop a deep infection and there were 6(8.4%) non-unions. Infection rate for patients in less than 6 hr group and more than 6 hrs group were 13.1% and 10.8% respectively. No statisticlly significant difference could be demonstrated between the two groups (P=0.56) While there was no significant relationship between grade of fracture and infection rate (P=0.07), the relationship between grade of fracture and non union was significant (p=0.02). Discussion and Conclusion Our study shows that the risk of developing an infection was not increased if the primary surgical management was delayed more than 6 hours after injury. Therefore, reasonable delays in surgical treatment for patients with open fractures may be justified in order to provide an optimal operating environment.