Duane Therese M, Sercy Erica, Banton Kaysie L, Blackwood Brian, Hamilton David, Hentzen Andrew, Hatch Matthew, Akinola Kerrick, Gordon Jeffrey, Bar-Or David
Trauma Services Department, Medical Center of Plano, Plano, Texas, USA.
Trauma Research Department, Injury Outcomes Network, Englewood, Colorado, USA.
Trauma Surg Acute Care Open. 2022 Aug 30;7(1):e000952. doi: 10.1136/tsaco-2022-000952. eCollection 2022.
Open fractures are at risk of infection because of exposure of bone and tissue to the environment. Facial fractures are often accompanied by other severe injuries, and therefore fracture management may be delayed until after stabilization. Previous studies in this area have examined timing of multiple facets of care but have tended to report on each in isolation (eg, antibiotic initiation).
This was a retrospective study of adult patients admitted to five trauma centers from January 1, 2017 to March 31, 2021 with open facial fractures. Variables collected included demographics, injury mechanism, details on facial and non-facial injuries, facial fracture management (irrigation and debridement (I&D), irrigation without debridement, open reduction internal fixation (ORIF), antibiotics), and other hospital events. The study hypothesized that the presence of serious non-facial injuries would be associated with delays in facial fracture management. The primary aims were to describe open facial fracture management practices and examine factors associated with early versus delayed fracture management. A secondary aim was to describe infection rates. Early treatment was defined as within 24 hours of arrival for I&D, irrigation without debridement, and ORIF and within 1 hour for antibiotics.
A total of 256 patients were included. Twenty-seven percent had major trauma (Injury Severity Score ≥16). The presence of serious head injury/traumatic brain injury was associated with delayed I&D (OR=0.04, p<0.01), irrigation without debridement (OR=0.09, p<0.01), and ORIF (OR=0.10, p<0.01). Going to the OR within 24 hours was associated with early I&D (OR=377.26, p<0.01), irrigation without debridement (OR=13.54, p<0.01), and ORIF (OR=154.92, p<0.01). The infection rate was 4%.
In this examination of multiple aspects of open facial fracture management, serious injuries to non-facial regions led to delays in surgical fracture management, consistent with the study hypothesis.
Level III, prognostic/epidemiological.
开放性骨折因骨骼和组织暴露于外界环境而有感染风险。面部骨折常伴有其他严重损伤，因此骨折治疗可能会延迟至伤情稳定之后。此前该领域的研究已探讨了多方面治疗的时机，但往往是孤立地报告每个方面（如抗生素的使用时机）。
这是一项针对2017年1月1日至2021年3月31日期间入住五家创伤中心的成年开放性面部骨折患者的回顾性研究。收集的变量包括人口统计学资料、损伤机制、面部和非面部损伤的详细情况、面部骨折治疗措施（冲洗清创术（I&D）、单纯冲洗、切开复位内固定术（ORIF）、抗生素使用情况）以及其他医院相关事件。该研究假设严重的非面部损伤会导致面部骨折治疗延迟。主要目的是描述开放性面部骨折的治疗方法，并研究与早期或延迟骨折治疗相关的因素。次要目的是描述感染率。早期治疗定义为：冲洗清创术、单纯冲洗以及切开复位内固定术在伤后24小时内进行，抗生素在伤后1小时内使用。
共纳入256例患者。27%的患者遭受严重创伤（损伤严重度评分≥16）。严重头部损伤/创伤性脑损伤与延迟的冲洗清创术（比值比[OR]=0.04，p<0.01）、单纯冲洗（OR=0.09，p<0.01）和切开复位内固定术（OR=0.10，p<0.01）相关。伤后24小时内进行手术与早期冲洗清创术（OR=377.26，p<0.01）、单纯冲洗（OR=13.54，p<0.01）和切开复位内固定术（OR=154.92，p<0.01）相关。感染率为4%。
在本次对开放性面部骨折治疗多个方面的研究中，非面部区域的严重损伤导致手术骨折治疗延迟，这与研究假设一致。
三级，预后/流行病学研究。
