Objectives: To evaluate the association between time to
surgery, antibiotic administration, Gustilo grade, fracture location,
and development of deep infection in open fractures.
Setting: Three Level 1 Canadian trauma centers.
Participants: A total of 736 (791 fractures) subjects
were enrolled and 686 subjects (93%; 737 fractures) provided adequate
follow-up data (1-year interview and/or clinical follow-up >90 days).
Intervention: Demographics, injury information, time
to surgery, and antibiotics were recorded. Subjects were evaluated using
standardized data forms until the fracture(s) healed. Phone interviews
were undertaken 1 year after the fracture.
Main Outcome Measures: Infection requiring unplanned surgical debridement and/or sustained antibiotic therapy.
Results: Tibia/fibula fractures were most common (n =
413, 52%), followed by upper extremity (UE) (n = 285, 36%), and femoral
(n = 93, 12%) fractures. Infection developed in 46 fractures (6%). The
median time to surgery was 9 hours 4 minutes (interquartile range, 6
hours 39 minutes to 12 hours 33 minutes) and 7 hours 39 minutes
(interquartile range, 6 hours 10 minutes to 9 hours 54 minutes) for
those without and with infection, respectively (P = 0.04). Gustilo grade 3B/3C fractures accounted for 17 of 46 infections (37%) (P < 0.001). Four UE (1.5%), 7 femoral (8%), and 35 tibia/fibula (9%) fractures developed infections (P
= 0.001). Multivariate regression found no association between
infection and time to surgery [odds ratio (OR), 0.97; 95% confidence
interval (95% CI), 0.90–1.06] or antibiotics (OR, 1.0; 95% CI,
0.90–1.05). Grades 3A (OR, 6.37; 95% CI, 1.37–29.56) and 3B/3C (OR,
12.87; 95% CI, 2.72–60.95) relative to grade 1 injuries and tibia/fibula
(OR, 3.91; 95% CI, 1.33–11.53) relative to UE fractures were
significantly associated with infection.
Conclusion: Infection after open fracture was
associated with increasing Gustilo grade or tibia/fibula fractures but
not time to surgery or antibiotics.
