Open tibia fractures: Analysis of correlation between timing of intervention, mode of management and outcome
Journal Title: Medpulse International Journal of Orthopedics - Year 2019, Vol 10, Issue 1
Abstract
Background: Open fractures are one of the common emergencies seen in orthopaedics. The traditional teaching was that wound debridement preferably be completed within 6 hours. Current literature suggests no obvious advantage in performing debridement within 6 hours compared to debridement performed between 6 and 24 hours after injury. Our study aims to compare the outcomes of open tibia shaft fractures which were managed (i.e., initial wound debridement) within first 24hrs with those which could not be managed within first 24hrs (i.e., >24hrs) due to various reasons. Materials and Methods: A total of 49 open tibia fracture cases managed in our hospital from June 2017 to June 2018 were analysed based on the mode of injury, time from injury to intervention, method of fixation, use of antibiotics, fracture classification based on Gustilo Anderson classification for open fractures, functional outcome and development of two major complications i.e., infection and non union. All the patients underwent initial open fracture management protocol in the casualty i.e., wound irrigation, tetanus prophylaxis and i.v. antibiotics based on hospital antibiotics policy and culture swabs were taken when cases got delayed for >24hrs. The patients were divided into those operated <24hrs, 24-48hrs, 48-72hrs, 72-96hrs and >96 hrs and method of fixation i.e., IMIL nail or External fixator. Complications developed among them were analysed over a period of 6weeks, 3months, 6months and a maximum follow up of 1year. Comparison among the categorical variables was done using Chi square analysis and p value < 0.05 was considered significant. Statistical analysis was done using SPSS 16 software. Results: In previous studies, the data were based on surgical debridement done at <24 hours which showed infection rates of none to 2%, 2% to 10%, and 10% to 50% for Gustilo-Anderson types I, II, and III respectively. These values were similar in our study which showed infection rate of 0,0 and 25% when debridement was done <24hrs and 0,0 and 50% when debridement was done >24hrs for types I, II and III respectively. The data analysis done showed no correlation between type I and II open tibia fractures, timing of surgery and development of complications(i.e., p-value >0.05). Though the results were statistically insignificant (i.e., p-value >0.05) in open type III, a gradual increase in the rate of infection and non union with increase in timing of surgery in cases operated >24hrs was noted. Conclusion: Surgical debridement of open fractures should be performed as emergency for the limb salvage and better results in terms of functional outcome. But, the risk of infection and non-union is not strongly correlated to a delay to surgery. Open fracture management requires respect for several universally accepted principles in order to mitigate the risks of infection and non-union. The decision should be made on case-by-case basis, with medical optimization and trauma resuscitation always taking precedence over orthopaedic fixation and management.
Authors and Affiliations
Siddalingamurthy G, Madhukesh Rudramurthy, Sachin Patel, Vijay C, Sujana Theja JS
Keywords
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- EP ID EP590580
- DOI 10.26611/10201014
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