Chapman M W, Mahoney M
Clin Orthop Relat Res. 1979 Jan-Feb(138):120-31.
A series of 101 victims of multiple trauma and open fractures were treated by early open reduction and internal fixation. Some of the fractures included associated vascular injury. Some of the patients had extensive intraarticular fractures. Femur fractures in the elderly were included. All wounds were left open. In 94 patients, the early infection rate was 1.9% in small clean open (type I) wounds, 8% in large open (type II) wounds, and 41% in extensively contused large open (type III) wounds. In 94 cases the overall infection rate was 10.6%. In only one infection (1%) a long-term chronic osteomyelitis ensued; there were no non-unions in long bone fractures. Open fractures with type I wounds have the same infection rate as reported for closed fractures. In fractures with types II and III wounds salvage of limb, life, or joint function must justify the high risk of infection. Immediate plate fixation of severe open fractures of the tibia could save a limb from amputation. Closed intramedullary nailing of open fractures of the femur carries a high rate of success.
101例多发伤和开放性骨折患者接受了早期切开复位内固定治疗。部分骨折伴有血管损伤。部分患者存在广泛的关节内骨折。纳入了老年患者的股骨骨折。所有伤口均保持开放。在94例患者中，小的清洁开放性（I型）伤口的早期感染率为1.9%，大的开放性（II型）伤口为8%，广泛挫伤的大开放性（III型）伤口为41%。94例患者的总体感染率为10.6%。仅1例感染（1%）发展为长期慢性骨髓炎；长骨骨折无骨不连。I型伤口的开放性骨折感染率与闭合性骨折报道的相同。对于II型和III型伤口的骨折，肢体、生命或关节功能的挽救必须证明感染的高风险是合理的。立即对严重的胫骨开放性骨折进行钢板固定可避免肢体截肢。股骨开放性骨折的闭合髓内钉固定成功率很高。
