Infections in open fractures of the hand.

We reviewed one forty-six consecutive cases of patients with open fractures of the hand to identify factors that predict infection and poor outcome. The incidence of infection was 11%. The infection rate in type 1 open fractures was 0%; in type 2, 9%; and in type 3, 14%. Infection occurred in 20.5% of grossly contaminated wounds (p less than 0.02), and was most common in patients with extensive soft tissue and skeletal injury. Delay in treatment did not increase the incidence of infection or affect outcome. Functional outcome was highly correlated with the initial fracture type and with the presence of infection. Preoperative wound cultures were of no value in predicting the risk of infection or the nature of the likely pathogen. Patients with severe open fractures should be warned of the risk of infection, prolonged convalescence, and permanent impairment.