Justin W Zumsteg1, Cesar S Molina2, Donald H Lee2, Nick D Pappas2. 1. Department of Orthopedics, Vanderbilt University Medical Center, Nashville, TN; Greenville Health System/Steadman-Hawkins Clinic of the Carolinas, Greenville, SC.. Electronic address: Justin.Zumsteg@Vanderbilt.edu. 2. Department of Orthopedics, Vanderbilt University Medical Center, Nashville, TN; Greenville Health System/Steadman-Hawkins Clinic of the Carolinas, Greenville, SC.
Abstract
PURPOSE: To investigate factors associated with the development of deep infection in patients with open fractures of the radius and/or ulna. METHODS: We retrospectively reviewed 296 open fractures of the radius and/or ulna. Of these patients, 200 had at least 6-month follow-up and were included in this study. The following variables were examined for each patient: time from injury to antibiotic administration, time from injury to operative debridement, Gustilo-Anderson classification, type of antibiotic received, and host characteristics such as age, diabetes, and tobacco use. Outcome parameters included the presence of deep infection and fracture union. RESULTS: The overall rate of deep infection was 5% (10 of 200). No type 1 fractures (of 41) developed deep infection. In contrast, 4% (2 of 48) of type 2 and 7% (8 of 110) of type 3 fractures developed infection. Of 200 patients, 28 received antibiotics in less than 3 hours and underwent debridement in less than 6 hours from the time of injury; however, they did not have lower rates of infection. Similar findings were noted when nonunion was used as the outcome, and the association between Gustilo-Anderson classification and the development of nonunion was statistically significant. CONCLUSIONS: Factors such as time to antibiotics and time to operative debridement were not predictors for either rate of deep infection or nonunion in open fractures of the radius and/or ulna. The type of fracture as outlined by the Gustilo-Anderson classification was the factor most strongly associated with the development of deep infection and nonunion in these fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
PURPOSE: To investigate factors associated with the development of deep infection in patients with open fractures of the radius and/or ulna. METHODS: We retrospectively reviewed 296 open fractures of the radius and/or ulna. Of these patients, 200 had at least 6-month follow-up and were included in this study. The following variables were examined for each patient: time from injury to antibiotic administration, time from injury to operative debridement, Gustilo-Anderson classification, type of antibiotic received, and host characteristics such as age, diabetes, and tobacco use. Outcome parameters included the presence of deep infection and fracture union. RESULTS: The overall rate of deep infection was 5% (10 of 200). No type 1 fractures (of 41) developed deep infection. In contrast, 4% (2 of 48) of type 2 and 7% (8 of 110) of type 3 fractures developed infection. Of 200 patients, 28 received antibiotics in less than 3 hours and underwent debridement in less than 6 hours from the time of injury; however, they did not have lower rates of infection. Similar findings were noted when nonunion was used as the outcome, and the association between Gustilo-Anderson classification and the development of nonunion was statistically significant. CONCLUSIONS: Factors such as time to antibiotics and time to operative debridement were not predictors for either rate of deep infection or nonunion in open fractures of the radius and/or ulna. The type of fracture as outlined by the Gustilo-Anderson classification was the factor most strongly associated with the development of deep infection and nonunion in these fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
Authors: Kyle E Nappo; Benjamin W Hoyt; George C Balazs; George P Nanos; Derek F Ipsen; Scott M Tintle; Elizabeth M Polfer Journal: Clin Orthop Relat Res Date: 2019-04 Impact factor: 4.176
Authors: Kirsten Kortram; Hans Bezstarosti; Willem-Jan Metsemakers; Michael J Raschke; Esther M M Van Lieshout; Michael H J Verhofstad Journal: Int Orthop Date: 2017-07-25 Impact factor: 3.075