*R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and †Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Orthop Trauma. 2014 May;28(5):288-93. doi: 10.1097/BOT.0000000000000001.
The importance of the timing of flap coverage of open tibial shaft fractures remains controversial. Many studies have shown increased complications and infection rates associated with delay in coverage but have not controlled for risk factors that might be associated with both delay in coverage and complications. We hypothesized that the timing of flap coverage of open tibial fractures is not predictive of complications after controlling for known risk factors.
Retrospective review.
Level I trauma center.
Sixty-nine patients treated for acute tibial fractures (45 tibial shaft, 17 plateau, and 12 pilon fractures) at our center from 2004 through 2009 required 74 flaps. Patients requiring flaps later for wound breakdown or infection were excluded.
Electronic records and prospective trauma database were reviewed. All fractures were AO classified by a trauma fellowship-trained orthopaedic surgeon.
Primary outcome was flap complication, defined as infection or other flap-related adverse outcome requiring surgical treatment. Logistic regression analysis was conducted.
A logistic regression model that separated the first 7 days after injury from subsequent days found no increased risk for days 1 through 7. The odds of complications, and of infection in particular, increased by 11% and 16%, respectively, for each day beyond day 7 (P < 0.04).
Even after controlling for known risk factors for complications, including injury severity, time to flap coverage was a significant predictor of complications.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
胫骨开放性骨折皮瓣覆盖时机的重要性仍存在争议。许多研究表明，皮瓣覆盖延迟与并发症和感染率增加有关，但并未控制可能与覆盖延迟和并发症都有关的风险因素。我们假设，在控制已知的风险因素后，胫骨开放性骨折皮瓣覆盖的时间与并发症无关。
回顾性研究。
一级创伤中心。
2004 年至 2009 年，我们中心治疗的 69 例急性胫骨骨折（45 例胫骨骨干，17 例胫骨平台，12 例 Pilon 骨折）需要 74 个皮瓣。排除因伤口破裂或感染而需要后期皮瓣的患者。
电子病历和前瞻性创伤数据库进行了回顾。所有骨折均由创伤 fellowship培训的骨科医生进行 AO 分类。
主要结果是皮瓣并发症，定义为需要手术治疗的感染或其他与皮瓣相关的不良后果。进行了逻辑回归分析。
将损伤后第 1 天至第 7 天与随后的天数分开的逻辑回归模型发现，第 1 天至第 7 天并无增加的风险。第 7 天后，并发症的几率，特别是感染的几率，分别增加了 11%和 16%（P <0.04）。
即使在控制包括损伤严重程度在内的并发症的已知风险因素后，皮瓣覆盖时间仍然是并发症的重要预测因素。
治疗 III 级。请参阅作者说明以获取完整的证据水平描述。
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