Department of Orthopedics and Rehabilitation, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, TX 78234, USA.
J Trauma Acute Care Surg. 2012 Apr;72(4):1062-7. doi: 10.1097/TA.0b013e318241f534.
Type III open tibia fractures are common combat injuries. The purpose of the study was to evaluate the effect of injury characteristics and surveillance cultures on outcomes in combat-related severe open tibia fractures.
We conducted a retrospective study of all combat-related open Gustilo and Anderson (G/A) type III diaphyseal tibia fractures treated at our centers between March 2003 and September 2007.
One hundred ninety-two Operation Iraqi Freedom/Operation Enduring Freedom military personnel with 213 type III open tibial shaft fractures were identified. Fifty-seven extremities (27%) developed a deep infection and 47 extremities (22%) ultimately underwent amputation at an average follow-up of 24 months. Orthopedic Trauma Association type C fractures took significantly longer to achieve osseous union (p = 0.02). G/A type III B and III C fractures were more likely to undergo an amputation and took longer to achieve fracture union. Deep infection and osteomyelitis were significantly associated with amputation, revision operation, and prolonged time to union. Surveillance cultures were positive in 64% of extremities and 93% of these cultures isolated gram-negative species. In contrast, infecting organisms were predominantly gram-positive.
Type III open tibia fractures from combat unite in 80.3% of cases at an average of 9.2 months. We recorded a 27% deep infection rate and a 22% amputation rate. The G/A type is associated with development of deep infection, need for amputation, and time to union. Positive surveillance cultures are associated with development of deep infection, osteomyelitis, and ultimate need for amputation. Surveillance cultures were not predictive of the infecting organism if a deep infection subsequently develops.
III 型开放性胫骨骨折是常见的战伤。本研究旨在评估损伤特征和监测培养物对战斗相关严重开放性胫骨骨折结局的影响。
我们对 2003 年 3 月至 2007 年 9 月期间在我们中心治疗的所有与战斗相关的 Gustilo 和 Anderson（G/A）III 型骨干开放性胫骨骨折患者进行了回顾性研究。
确定了 192 名参与伊拉克自由行动/持久自由行动的军事人员，他们共有 213 例 III 型开放性胫骨骨干骨折。57 个肢体（27%）发生深部感染，47 个肢体（22%）最终在平均 24 个月的随访中截肢。骨科创伤协会 C 型骨折骨愈合时间明显延长（p=0.02）。G/A III B 和 III C 型骨折更有可能截肢，且骨折愈合时间更长。深部感染和骨髓炎与截肢、翻修手术和愈合时间延长显著相关。监测培养物阳性率为 64%，其中 93%的培养物分离出革兰阴性菌。相比之下，感染的病原体主要是革兰阳性菌。
来自战斗的 III 型开放性胫骨骨折的愈合率为 80.3%，平均愈合时间为 9.2 个月。我们记录到深部感染率为 27%，截肢率为 22%。G/A 型与深部感染、截肢和愈合时间有关。阳性监测培养物与深部感染、骨髓炎和最终截肢的需要有关。如果深部感染随后发生，监测培养物并不能预测感染的病原体。
