Winner of the 2006 Alexandra Kirkley Award

Best Clinical Paper Presented at the 2006 CORA Annual Meeting

Timing of Operative Management In the Treatment of Open Fractures: Does Delay to OR Increase the Risk of Complications?

Sonja Mathes, M.D.
Vancouver, BC

Pierre Guy, M.D., FRCSC

Introduction: Open fractures remain a true orthopaedic emergency with surgical débridement six to eight hours from injury being the standard of care. This timing, however, is based on historical principles and in vitro data with little supporting evidence.

Study Objective: To determine if delay to operative irrigation and débridement is a risk for development of deep infection or non-union in open fractures.

Methods: Retrospective study of open fractures treated at a tertiary Trauma Centre between 1990 and 2002. Database review focussed on three areas: (i) patient and fracture characteristics; (ii) operative management; (iii) complications. Cases were defined as fractures requiring operative management of infection or non-union, with remaining fractures defined as controls.

Results: 891 open long bone fractures were identified. There were 99 cases of deep infection or non-union. Case control and cohort study study analysis did not demonstrate any increased risk of complication with delayed débridement. High energy and lower extremity fractures had increased risk of complications. Matched case control and adjusted cohort study analysis, accounting for energy and extremity, also did not demonstrate any increased risk of infection or non-union with delayed OR.