Kock Frans W, Basson Tinus R, Burger Marilize C, Ferreira Nando
Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
Strategies Trauma Limb Reconstr. 2025 Jan-Apr;20(1):25-30. doi: 10.5005/jp-journals-10080-1640. Epub 2025 Aug 18.
Controversy remains on the most effective method of treating open tibia shaft fractures. The timing of the different treatment variables remains at the heart of this dispute. This study aimed to investigate outcomes of open tibial shaft fractures. Specific objectives were to determine the association of time delay to antibiotic administration, surgical debridement, definitive skeletal stabilisation and soft tissue reconstruction, and the development of fracture-related infection (FRI).
A total of 227 patients with 237 open tibia shaft fractures were included. The time from arrival to (1) antibiotic administration (<3 hours vs >3 hours); (2) primary debridement in theatre (<24 hours vs >24 hours); (3) definitive skeletal stabilization (<5 days vs >5 days); (4) definitive soft tissue reconstruction (<5 vs >5 days); and (5) time to union was recorded. The number of debridements and the length of hospital stay were also recorded.
Patients who waited more than 5 days for definitive skeletal fixation or soft tissue reconstruction had a significant increase in FRI [odds ratio (OR) 4.7, 95% confidence intervals (CI): 2.0-10.9 and OR 4.7, 95% CI: 2.0-11.0, respectively]. Patients who underwent more than two formal debridements also had a higher risk of developing FRI than those who only had ≤2 debridements (OR 15.6, 95% CI: 5.8-41.6).
Time delays in managing open tibia shaft fractures are associated with an increased risk of FRI. Definitive soft tissue reconstruction and skeletal stabilisation should not be delayed for more than 5 days.
Fracture-related infection following open tibia shaft fractures can be mitigated by reducing treatment delays, specific to definitive soft tissue reconstruction and skeletal stabilisation.
Kock FM, Basson TR, Burger MC, . The Effect of Treatment Delays on Fracture-related Infection in Open Tibia Shaft Fractures: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr 2025;20(1):25-30.
对于开放性胫骨干骨折最有效的治疗方法仍存在争议。不同治疗变量的时机仍是这场争论的核心。本研究旨在调查开放性胫骨干骨折的治疗结果。具体目标是确定抗生素给药、手术清创、确定性骨骼固定和软组织重建的时间延迟与骨折相关感染（FRI）发生之间的关联。
共纳入227例患者的237处开放性胫骨干骨折。记录从入院到（1）抗生素给药（<3小时与>3小时）；（2）在手术室进行一期清创（<24小时与>24小时）；（3）确定性骨骼固定（<5天与>5天）；（4）确定性软组织重建（<5天与>5天）；以及（5）骨折愈合时间。还记录了清创次数和住院时间。
等待超过5天进行确定性骨骼固定或软组织重建的患者发生FRI的风险显著增加[优势比（OR）分别为4.7，95%置信区间（CI）：2.0 - 10.9和OR 4.7，95% CI：2.0 - 11.0]。接受超过两次正式清创的患者发生FRI的风险也高于仅进行≤2次清创的患者（OR 15.6，95% CI：5.8 - 41.6）。
开放性胫骨干骨折治疗延迟与FRI风险增加相关。确定性软组织重建和骨骼固定不应延迟超过5天。
通过减少治疗延迟，特别是确定性软组织重建和骨骼固定的延迟，可以减轻开放性胫骨干骨折后的骨折相关感染。
Kock FM, Basson TR, Burger MC, 。治疗延迟对开放性胫骨干骨折骨折相关感染的影响：一项回顾性队列研究。《创伤肢体重建策略》2025；20(1):25 - 30。
