Hadizie D, Kor Y S, Ghani S A, Mohamed-Saat M A
Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Malays Orthop J. 2022 Nov;16(3):24-29. doi: 10.5704/MOJ.2211.005.
The primary aim of open fracture management is to prevent fracture-related infection by early antibiotic administration, debridement and wound coverage. However, the timing of the initial debridement is still controversial, and 6 to 24 hours is commonly advocated. Studies have yet to provide substantial evidence regarding the best time for surgical debridement. Thus, this study was conducted to compare the incidence of fracture-related infection at different time intervals of initial debridement of the open tibia fracture.
A total of 91 patients with grade I, II and IIIa open tibia fractures were recruited from 2016 to 2018, and their data were obtained from the consensus book and medical records. Participants were divided into four groups based on the time of initial debridement: (1) less than 6 hours, (2) 6 to less than 12 hours, (3) 12 to less than 24 hours, and (4) 24 hours and more. Fracture-related infection was determined by using Metsemakers confirmative criteria. Association between time and infection were determine by Binary Logistic Regression analysis by remerged the group into three; (1) less than 12 hours, (2) 12 to less than 24 hours and (3) 24 hours and more. The collected information was analysed using SPSS version 24 and Microsoft Excel 2010.
The mean age of the participants was 31.9 years old, with male predominant (n=80, 87.0%). Most participants had delayed initial debridement of more than 24 hours and predominantly Gustilo-Anderson type IIIa (n=47). A total of 8 fractures complicated with infection (8.7%), majority in grade IIIa and debridement performed within 12 to less than 24 hours. Binary logistic regression showed increased odds of infection with a delayed wound debridement both in clinical presentation and positive culture, but the association was not statistically significant. The commonest organism isolated was Pseudomonas aeruginosa.
Comparing to different time interval, initial wound debridement of more than 24 hours did not have strong association with increasing infection rate. However, even though statistically not significant, the odds of infection was increase with increasing time of initial wound debridement of an open tibia fracture, thus it should be performed early.
开放性骨折治疗的主要目标是通过早期使用抗生素、清创和伤口覆盖来预防骨折相关感染。然而，首次清创的时机仍存在争议，目前普遍主张在6至24小时内进行。关于手术清创的最佳时机，研究尚未提供充分的证据。因此，本研究旨在比较开放性胫骨骨折初次清创在不同时间间隔下骨折相关感染的发生率。
2016年至2018年共招募了91例I级、II级和IIIa级开放性胫骨骨折患者，其数据来自共识手册和病历。根据初次清创时间将参与者分为四组：（1）少于6小时，（2）6至少于12小时，（3）12至少于24小时，（4）24小时及以上。采用Metsemakers确诊标准确定骨折相关感染。通过将组重新合并为三组，采用二元逻辑回归分析确定时间与感染之间的关联：（1）少于12小时，（2）12至少于24小时，（3）24小时及以上。使用SPSS 24版和Microsoft Excel 2010对收集到的信息进行分析。
参与者的平均年龄为31.9岁，以男性为主（n = 80，87.0%）。大多数参与者初次清创延迟超过24小时，主要为Gustilo-Anderson IIIa型（n = 47）。共有8例骨折并发感染（8.7%），大多数为IIIa级，清创在12至少于24小时内进行。二元逻辑回归显示，无论是临床表现还是阳性培养，伤口清创延迟都会增加感染几率，但这种关联在统计学上并不显著。分离出的最常见病原体是铜绿假单胞菌。
与不同时间间隔相比，初次伤口清创超过24小时与感染率增加没有强烈关联。然而，尽管在统计学上不显著，但开放性胫骨骨折初次伤口清创时间越长，感染几率越高，因此应尽早进行清创。
