Comparison of delayed and primary wound closure in the treatment of open tibial fractures.

INTRODUCTION: Primary wound closure in the management of open tibial fractures has generally been discouraged. Several prior studies suggest that infections are not caused by the initial contamination, but are instead the result of organisms acquired in the hospital. Primary wound closure after adequate wound care and fracture stabilisation could therefore be considered a reasonable option.
MATERIALS AND METHODS: We analysed 95 patients with open tibial fractures (Gustilo-Anderson type 1 to 3A) treated with primary fracture stabilisation and either delayed wound closure (group I) or primary wound closure (group II), with a minimum follow-up of 12 months.
RESULTS: Group I included 46 patients with a mean age of 30.2 years (16-56), and a mean follow-up of 13.5 months (12-18). Group II included 49 patients with a mean age of 33.4 (18-69), and a mean follow up of 13.7 months (12-16). One infection developed in group I (2%), and two infections developed in group II (4%). This difference was not found to have any statistical significance.
CONCLUSION: Our results support other recent reports that the infection rate is not increased following primary wound closure after thorough debridement of less severe open fractures. The length of stay following primary closure (group II) was significantly shorter, and that should result in substantially more cost effective care of these serious injuries. We conclude that primary wound closure is a safe option in properly selected cases. Prospective multi-centre studies are needed to further evaluate the safety and efficacy of this treatment alternative.