The Incidence of Fracture-Related Infection in Open Tibia Fracture with Different Time Interval of Initial Debridement

INTRODUCTION: 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.

MATERIALS AND METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.