http://www.bjj.boneandjoint.org.uk/content/96-B/3/379.abstract
Delayed debridement of severe open fractures is associated with a higher rate of deep infection
S. C. Johnson, MD, Orthopaedic Surgeon2;
D. J. G. Stephen, MD, FRCS (C), Associate Professor 3;
H. J. Kreder, MD, MPH, FRCS(C), Professor of Orthopaedic Surgery4; and
+ Author Affiliations
1Cambridge University Hospitals, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
2Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.
3Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.
4Sunnybrook Health Sciences Centre and University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada.
Correspondence should be sent to Mr P. D. Hull; e-mail:peter.hull@addenbrookes.nhs.uk
Desbridamiento tardío de las fracturas expuestas graves se asocia con una mayor tasa de infección profunda
Delayed debridement of severe open fractures is associated with a higher rate of deep infection
S. C. Johnson, MD, Orthopaedic Surgeon2;
D. J. G. Stephen, MD, FRCS (C), Associate Professor 3;
H. J. Kreder, MD, MPH, FRCS(C), Professor of Orthopaedic Surgery4; and
+ Author Affiliations
1Cambridge University Hospitals, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
2Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.
3Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.
4Sunnybrook Health Sciences Centre and University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada.
Correspondence should be sent to Mr P. D. Hull; e-mail:peter.hull@addenbrookes.nhs.uk
Desbridamiento tardío de las fracturas expuestas graves se asocia con una mayor tasa de infección profunda
Resumen
Este estudio explora la relación entre el retraso del desbridamiento quirúrgico y la infección profunda en una serie de 364 pacientes consecutivos con 459 fracturas abiertas tratadas a nivel de un hospital de trauma académica en América del Norte.
La media de retardo para el desbridamiento de todas las fracturas fue de 10,6 horas ( 0,6 a 111,5 ) . Hubo 46 infecciones profundas (10%) . No hubo infecciones entre el 55 grado Gustilo -Anderson abro fracturas. Entre los de grado II y III lesiones, un aumento estadísticamente significativo en la tasa de infección profunda fue encontrado por cada hora de retraso (OR = 1,033 ; IC del 95%: 1,01 a 1,057 ) . Esta relación muestra un aumento lineal del 3 % por cada hora de retraso. No se identificaron tiempo distinto puntos de corte . Infección profunda también se asoció con fracturas de tibia ( OR = 2,44 : IC del 95 %: 1,26 a 4,73) , un grado más alto Gustilo -Anderson (OR = 1,99 : IC 95 % 1,004-3,954 ) , y contaminación de la fractura (OR = 3,12 : IC del 95 %: 1,36 a 7,36) . Estos efectos individuales son aditivos , lo que sugiere que el retraso de desbridamiento tendrá un efecto perjudicial clínicamente significativo en las fracturas abiertas más graves .
Retraso en el tratamiento parecía segura para el grado 1 fracturas abiertas . Sin embargo, cuando los factores pronósticos negativos de sitio tibial , de alto grado de fractura y / o la contaminación están presentes recomendamos desbridamiento quirúrgico urgente .
Este estudio explora la relación entre el retraso del desbridamiento quirúrgico y la infección profunda en una serie de 364 pacientes consecutivos con 459 fracturas abiertas tratadas a nivel de un hospital de trauma académica en América del Norte.
La media de retardo para el desbridamiento de todas las fracturas fue de 10,6 horas ( 0,6 a 111,5 ) . Hubo 46 infecciones profundas (10%) . No hubo infecciones entre el 55 grado Gustilo -Anderson abro fracturas. Entre los de grado II y III lesiones, un aumento estadísticamente significativo en la tasa de infección profunda fue encontrado por cada hora de retraso (OR = 1,033 ; IC del 95%: 1,01 a 1,057 ) . Esta relación muestra un aumento lineal del 3 % por cada hora de retraso. No se identificaron tiempo distinto puntos de corte . Infección profunda también se asoció con fracturas de tibia ( OR = 2,44 : IC del 95 %: 1,26 a 4,73) , un grado más alto Gustilo -Anderson (OR = 1,99 : IC 95 % 1,004-3,954 ) , y contaminación de la fractura (OR = 3,12 : IC del 95 %: 1,36 a 7,36) . Estos efectos individuales son aditivos , lo que sugiere que el retraso de desbridamiento tendrá un efecto perjudicial clínicamente significativo en las fracturas abiertas más graves .
Retraso en el tratamiento parecía segura para el grado 1 fracturas abiertas . Sin embargo, cuando los factores pronósticos negativos de sitio tibial , de alto grado de fractura y / o la contaminación están presentes recomendamos desbridamiento quirúrgico urgente .
Abstract
This study explores the relationship between delay to surgical debridement and deep infection in a series of 364 consecutive patients with 459 open fractures treated at an academic level one trauma hospital in North America.
The mean delay to debridement for all fractures was 10.6 hours (0.6 to 111.5). There were 46 deep infections (10%). There were no infections among the 55 Gustilo-Anderson grade I open fractures. Among the grade II and III injuries, a statistically significant increase in the rate of deep infection was found for each hour of delay (OR = 1.033: 95% CI 1.01 to 1.057). This relationship shows a linear increase of 3% per hour of delay. No distinct time cut-off points were identified. Deep infection was also associated with tibial fractures (OR = 2.44: 95% CI 1.26 to 4.73), a higher Gustilo-Anderson grade (OR = 1.99: 95% CI 1.004 to 3.954), and contamination of the fracture (OR = 3.12: 95% CI 1.36 to 7.36). These individual effects are additive, which suggests that delayed debridement will have a clinically significant detrimental effect on more severe open fractures.
Delayed treatment appeared safe for grade 1 open fractures. However, when the negative prognostic factors of tibial site, high grade of fracture and/or contamination are present we recommend more urgent operative debridement.
Cite this article: Bone Joint J 2014;96-B:379–84.
Footnotes
Internal funding from Marvin Tile Chair in Orthopaedic Surgery.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article
This article was primary edited by A. Ross a
This study explores the relationship between delay to surgical debridement and deep infection in a series of 364 consecutive patients with 459 open fractures treated at an academic level one trauma hospital in North America.
The mean delay to debridement for all fractures was 10.6 hours (0.6 to 111.5). There were 46 deep infections (10%). There were no infections among the 55 Gustilo-Anderson grade I open fractures. Among the grade II and III injuries, a statistically significant increase in the rate of deep infection was found for each hour of delay (OR = 1.033: 95% CI 1.01 to 1.057). This relationship shows a linear increase of 3% per hour of delay. No distinct time cut-off points were identified. Deep infection was also associated with tibial fractures (OR = 2.44: 95% CI 1.26 to 4.73), a higher Gustilo-Anderson grade (OR = 1.99: 95% CI 1.004 to 3.954), and contamination of the fracture (OR = 3.12: 95% CI 1.36 to 7.36). These individual effects are additive, which suggests that delayed debridement will have a clinically significant detrimental effect on more severe open fractures.
Delayed treatment appeared safe for grade 1 open fractures. However, when the negative prognostic factors of tibial site, high grade of fracture and/or contamination are present we recommend more urgent operative debridement.
Cite this article: Bone Joint J 2014;96-B:379–84.
Footnotes
Internal funding from Marvin Tile Chair in Orthopaedic Surgery.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article
This article was primary edited by A. Ross a
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