Department of Trauma and OrthopaedicsAddenbrooke's Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK.
School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK.
Arch Orthop Trauma Surg. 2023 Nov;143(11):6579-6587. doi: 10.1007/s00402-023-04956-1. Epub 2023 Jul 7.
Open diaphyseal tibial fractures are the most common long-bone fractures and require a rapid approach to prevent devastating complications. Current literature reports the outcomes of open tibial fractures. However, there is no robust, up-to-date research on the predictive indicators of infection severity in a large open tibial fracture patient cohort. This study investigated the predictive factors of superficial infections and osteomyelitis in open tibial fractures.
A retrospective analysis of the tibial fracture database was carried out from 2014 to 2020. Criteria for inclusion was any tibial fracture including tibial plateau, shaft, pilon or ankle, with an open wound at the fracture site. Exclusion criteria included patients with a follow-up period of less than 12 months and who are deceased. A total of 235 patients were included in our study, of which 154 (65.6%), 42 (17.9%), and 39 (16.6%) developed no infection, superficial infection, or osteomyelitis, respectively. Patient demographics, injury characteristics, fracture characteristics, infection status and management details were collected for all patients.
On multivariate modelling, patients with BMI > 30 (OR = 2.078, 95%CI [1.145-6.317], p = 0.025), Gustilo-Anderson (GA) type III (OR = 6.120, 95%CI [1.995-18.767], p = 0.001), longer time to soft tissue cover (p = 0.006) were more likely to develop a superficial infection, and patients with wound contamination (OR = 3.152, 95%CI [1.079-9.207], p = 0.036), GA-3 (OR = 3.387,95%CI [1.103-10.405], p = 0.026), longer to soft tissue cover (p = 0.007) were more likely to develop osteomyelitis. Univariate analysis also determined that risk factors for superficial infection were: BMI > 35 (OR = 6.107, 95%CI [2.283-16.332], p = 0.003) and wound contamination (OR = 2.249, 95%CI [1.015-5.135], p = 0.047); whilst currently smoking (OR = 2.298, 95%CI [1.087-4.856], p = 0.025), polytrauma (OR = 3.212, 95%CI [1.556-6.629], p = 0.001), longer time to definitive fixation (p = 0.023) were for osteomyelitis. However, none of these reached significance in multivariate analysis.
Higher GA classification is a significant risk factor for developing superficial infection and osteomyelitis, with a stronger association with osteomyelitis, especially GA 3C fractures. Predictors for superficial infection included BMI and time to soft tissue closure. Time to definitive fixation, time to soft tissue closure, and wound contamination were associated with osteomyelitis.
开放性胫骨骨折是最常见的长骨骨折，需要快速处理以预防严重并发症。目前的文献报告了开放性胫骨骨折的结果。然而，在大型开放性胫骨骨折患者队列中，关于感染严重程度的预测指标还没有强有力的最新研究。本研究调查了开放性胫骨骨折中浅表感染和骨髓炎的预测因素。
对 2014 年至 2020 年的胫骨骨折数据库进行了回顾性分析。纳入标准为任何胫骨骨折，包括胫骨平台、骨干、距骨或踝关节，骨折部位有开放性伤口。排除标准为随访时间少于 12 个月和死亡的患者。共有 235 例患者纳入本研究，其中 154 例（65.6%）、42 例（17.9%）和 39 例（16.6%）分别未发生感染、浅表感染或骨髓炎。收集了所有患者的人口统计学、损伤特征、骨折特征、感染状态和管理细节。
多变量模型显示，BMI>30（OR=2.078，95%CI [1.145-6.317]，p=0.025）、Gustilo-Anderson（GA）III 型（OR=6.120，95%CI [1.995-18.767]，p=0.001）、软组织覆盖时间较长（p=0.006）的患者更容易发生浅表感染，而伤口污染（OR=3.152，95%CI [1.079-9.207]，p=0.036）、GA-3（OR=3.387，95%CI [1.103-10.405]，p=0.026）、软组织覆盖时间较长（p=0.007）的患者更容易发生骨髓炎。单变量分析还确定了浅表感染的危险因素：BMI>35（OR=6.107，95%CI [2.283-16.332]，p=0.003）和伤口污染（OR=2.249，95%CI [1.015-5.135]，p=0.047）；而目前吸烟（OR=2.298，95%CI [1.087-4.856]，p=0.025）、多发伤（OR=3.212，95%CI [1.556-6.629]，p=0.001）、确定性固定时间较长（p=0.023）是骨髓炎的危险因素。然而，这些因素在多变量分析中均未达到显著性。
较高的 GA 分类是发生浅表感染和骨髓炎的显著危险因素，与骨髓炎的相关性更强，尤其是 GA 3C 骨折。预测浅表感染的因素包括 BMI 和软组织闭合时间。确定性固定时间、软组织闭合时间和伤口污染与骨髓炎有关。
