Schnetz M, Wengert A, Ruckes C, Jakobi T, Klug A, Gramlich Y
Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, D-60389 Frankfurt am Main, Germany.
Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, D-60389 Frankfurt am Main, Germany.
Injury. 2025 Jun;56(6):112303. doi: 10.1016/j.injury.2025.112303. Epub 2025 Mar 25.
Open fractures of the lower extremity have a higher risk of fracture-related infections (FRI) or nonunion. The purpose of this study was to identify risk factors for complications and evaluate outcomes.
In this retrospective, single center study, we identified and included 187 patients with extraarticular and intraarticular fractures of the tibia or fibula between 2010 and 2018. Patient characteristics, treatment protocols, and complications were assessed, with a focus on soft tissue management and timing of wound closure versus fracture fixation. To analyze risk factors for FRI and nonunion, a univariate logistic regression model was used.
The open fractures included were 52 Gustilo-Anderson type-I (28 %), 99 type-II (53 %), and 36 type-III (19 %) fractures. The mean time from admission to first surgical intervention was 3.47 h (SD 1.4), with 122 (60 %) patients treated within 3 h and 182 (97 %) patients, within 6 h. During primary surgery, definitive fracture fixation was carried out in 112 (60 %) patients and wound closure in 122 (65 %) patients. FRI was reported in 27 (14 %) patients with the highest prevalence in type-III fractures (31 %). Secondary wound closure was associated with a significantly higher risk for FRI than primary wound closure (odds ratio [OR] = 3.3; p = 0.004). Nonunion was reported in 37 (20 %) patients. Significant risk factors for nonunion were FRI (OR=11.9, p < 0.001) and definitive fracture fixation before wound closure compared to fracture fixation and wound closure at the same time (OR = 8.2, p < 0.001). Gustilo-Anderson type-IIIb and -IIIc fractures had a significant lower FRI-free survival compared to other fractures. No patient underwent amputation during the follow-up.
Open fractures of the tibia and fibula are associated with a high risk of FRI and nonunion. FRI is the strongest predictor of nonunion in open fractures of the lower extremity. Primary wound closure and simultaneous definitive fracture fixation are protective even in higher Gustilo-Anderson fracture types and prevent complications. Early antibiotic therapy and surgical treatment are crucial, as evidenced by all cases receiving treatment within 6 h post trauma.
下肢开放性骨折发生骨折相关感染（FRI）或骨不连的风险较高。本研究的目的是确定并发症的危险因素并评估治疗结果。
在这项回顾性单中心研究中，我们纳入了2010年至2018年间187例胫腓骨关节外和关节内骨折患者。评估了患者特征、治疗方案和并发症，重点关注软组织处理以及伤口闭合与骨折固定的时机。为分析FRI和骨不连的危险因素，使用了单因素逻辑回归模型。
纳入的开放性骨折中，52例为Gustilo-Anderson I型（28%），99例为II型（53%），36例为III型（19%）。从入院到首次手术干预的平均时间为3.47小时（标准差1.4），122例（60%）患者在3小时内接受治疗，182例（97%）患者在6小时内接受治疗。在初次手术中，112例（60%）患者进行了确定性骨折固定，122例（65%）患者进行了伤口闭合。27例（14%）患者发生FRI，其中III型骨折的发生率最高（31%）。二期伤口闭合与FRI的风险显著高于一期伤口闭合（比值比[OR]=3.3；p=0.004）。37例（20%）患者发生骨不连。骨不连的显著危险因素是FRI（OR=11.9，p<0.001）以及与同时进行骨折固定和伤口闭合相比，在伤口闭合前进行确定性骨折固定（OR=8.2，p<0.001）。与其他骨折相比，Gustilo-Anderson IIIb型和IIIc型骨折无FRI生存的比例显著较低。随访期间无患者接受截肢手术。
胫腓骨开放性骨折与FRI和骨不连的高风险相关。FRI是下肢开放性骨折骨不连的最强预测因素。一期伤口闭合和同时进行确定性骨折固定即使在较高的Gustilo-Anderson骨折类型中也具有保护作用，并可预防并发症。早期抗生素治疗和手术治疗至关重要，所有病例在创伤后6小时内接受治疗证明了这一点。
