Center of Excellence for Trauma & Surgical Critical Care, Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, North Carolina, USA.
Surg Infect (Larchmt). 2011 Oct;12(5):359-63. doi: 10.1089/sur.2010.075. Epub 2011 Sep 19.
Six hours from injury to washout is considered the gold standard in the treatment of open traumatic fractures. Despite this being our hospital policy, the rural nature of our Level I trauma center causes delays in discovery and transport, creating a unique randomization of time to washout. We hypothesized that orthopedic complications after open fractures are related to the severity of the fractures, not the timing of the washout.
Patients and fractures were reviewed retrospectively over 6.3 years, evaluating for demographics, injury severity, location of fracture, mechanism of injury, Gustilo fracture grade, and time from injury to initial washout. Orthopedic wound complication rates were compared using logistic regression.
A total of 1,487 open fractures in 1,278 patients were reviewed. Time from injury to washout was 26 to 4,749 min (mean, 510 min), with 48 patients having no washout. Overall, 8.2% of fractures (n=122) had an orthopedic complication, rates of which increased with severity (Injury Severity Score, Abbreviated Injury Score [AIS], and Gustilo class) and blunt injuries but were not related to time to washout. Penetrating injuries showed no difference in complication rates according to time to washout. Lower extremity fractures had a higher rate of complications than those of the upper extremity (odds ratio 2.2), likely because of differences in fracture grade. By multivariable logistic regression, only fracture grade, Revised Trauma Score (RTS), and male gender were independent predictors of wound complications; penetrating trauma was predictive of low risk. Time to washout was not an independent predictor of wound complications.
Although grossly contaminated fractures should not be left unattended, the degree of initial injury, as judged by fracture grade and physiology (RTS), was predictive of orthopedic wound complications, whereas time to washout was not. Hence, there is little benefit of washout in Gustilo grade 1/AIS 1 fractures or penetrating injuries, regardless of grade, and adherence to a specific time to washout is not beneficial.
伤后 6 小时内冲洗被认为是治疗开放性创伤性骨折的金标准。尽管这是我们医院的政策，但我们的一级创伤中心的农村性质导致了发现和运输的延迟，从而导致冲洗时间的独特随机化。我们假设开放性骨折后的骨科并发症与骨折的严重程度有关，而与冲洗时间无关。
对 6.3 年来的患者和骨折进行回顾性研究，评估人口统计学、损伤严重程度、骨折部位、损伤机制、Gustilo 骨折分级和从受伤到初次冲洗的时间。使用逻辑回归比较骨科伤口并发症发生率。
共回顾了 1278 名患者的 1487 例开放性骨折。从受伤到冲洗的时间为 26 至 4749 分钟（平均 510 分钟），有 48 例患者未进行冲洗。总体而言，8.2%（n=122）的骨折发生了骨科并发症，发生率随严重程度（损伤严重程度评分、简明损伤评分 [AIS] 和 Gustilo 分级）和钝性损伤而增加，但与冲洗时间无关。穿透性损伤根据冲洗时间的不同，并发症发生率没有差异。下肢骨折的并发症发生率高于上肢（优势比 2.2），可能是由于骨折分级的差异。通过多变量逻辑回归，只有骨折分级、修订创伤评分（RTS）和男性是伤口并发症的独立预测因素；穿透性创伤是低风险的预测因素。冲洗时间不是伤口并发症的独立预测因素。
尽管严重污染的骨折不应无人看管，但根据骨折分级和生理（RTS）判断的初始损伤程度是骨科伤口并发症的预测因素，而冲洗时间不是。因此，Gustilo 1/AIS 1 级骨折或穿透性损伤无论分级如何，冲洗都没有好处，并且坚持特定的冲洗时间也没有好处。
