The Relationship Between Time to Surgical Débridement and Incidence of Infection After Open High-Energy Lower Extremity Trauma

Pollak, Andrew N.; Jones, Alan L.; Castillo, Renan C.; Bosse, Michael J.; MacKenzie, Ellen J.
January 2010
Journal of Bone & Joint Surgery, American Volume;Jan2010, Vol. 92-A Issue 1, p7
Academic Journal
Background: Urgent débridement of open fractures has been considered to be of paramount importance for the prevention of infection. The purpose of the present study was to evaluate the relationship between the timing of the initial treatment of open fractures and the development of subsequent infection as well as to assess contributing factors. Methods: Three hundred and fifteen patients with severe high-energy lower extremity injuries were evaluated at eight level-I trauma centers. Treatment included aggressive débridement, antibiotic administration, fracture stabilization, and timely soft-tissue coverage. The times from injury to admission and operative débridement as well as a wide range of other patient, injury, and treatment-related characteristics that have been postulated to affect the risk of infection within the first three months after injury were studied, and differences between groups were calculated. In addition, multivariate logistic regression models were used to control for the effects of potentially confounding patient, injury, and treatment-related variables. Results: Eighty-four patients (27%) had development of an infection within the first three months after the injury. No significant differences were found between patients who had development of an infection and those who did not when the groups were compared with regard to the time from the injury to the first débridement, the time from admission to the first débridement, or the time from the first débridement to soft-tissue coverage. The time between the injury and admission to the definitive trauma treatment center was an independent predictor of the likelihood of infection. Conclusions: The time from the injury to operative débridement is not a significant independent predictor of the risk of infection. Timely admission to a definitive trauma treatment center has a significant beneficial influence on the incidence of infection after open high-energy lower extremity trauma. Level of Evidence: Prognostic LevelII. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Epidemiology and Contemporary Patterns of Trauma Deaths: Changing Place, Similar Pace, Older Face. Søreide, Kjetil; Krüger, Andreas J.; Vårdal, Anne Line; Ellingsen, Christian Lycke; Søreide, Eldar; Lossius, Hans Morten // World Journal of Surgery;Nov2007, Vol. 31 Issue 11, p2092 

    The epidemiology of trauma deaths in Europe is less than well investigated. Thus, our goal was to study the contemporary patterns of trauma deaths within a defined population with an exceptionally high trauma autopsy rate. This was a retrospective evaluation of 260 consecutive trauma autopsies...

  • The through-knee amputation/disarticulation. Ginsberg, J.W. // Journal of the Royal College of Surgeons of Edinburgh;Oct99, Vol. 44 Issue 5, p335 

    Presents an abstract of the study 'The Though-Knee Amputation/Disarticulation,' by J.W. Ginsberg, which was presented at the Joint Meeting of the Royal College of Physicians of Edinburgh and the Royal College of Surgeons of Edinburgh, with the College of Medicine of South Africa.

  • Focus on surgical care of the adolescent trauma patient. Sommerfeldt, D. // European Journal of Trauma & Emergency Surgery;Feb2014, Vol. 40 Issue 1, p1 

    An introduction is presented in which the editor discusses the surgical care of the adolescent trauma patient.

  • Complications of trauma care: Risk analysis of pneumonia in 10,001 adult trauma patients. Bellemare, Jean-Francois; Tepas III, J.J. // American Surgeon;Mar1996, Vol. 62 Issue 3, p207 

    Identifies complications of trauma care in a level I trauma center over a five-year period. Pneumonia; Mortality in patients with uncomplicated care; Severely injured patients as those with the most complications; Importance of infection control and aggressive pulmonary toilet in the early care...

  • DISCUSSION. Andros, George // Vascular Surgery;Mar/Apr1998, Vol. 32 Issue 2, p195 

    The article discusses some interesting points concerning the study on the proliferation of civilian trauma in the U.S. According to the author, what is interesting in the said case report is on the unusual injuries to intraabdominal structures including the occurrence of a rarity, renal artery...

  • Does Timing to Operative Debridement Affect Infectious Complications in Open Long-Bone Fractures? Schenker, Mara L.; Yannascoli, Sarah; Baldwin, Keith D.; Ahn, Jaimo; Mehta, Samir // Journal of Bone & Joint Surgery, American Volume;6/20/2012, Vol. 94-A Issue 12, p1057 

    Background: Existing guidelines recommend emergency surgical debridement of open fractures within six hours after injury. The aim of this study was to systematically review the association between time to operative debridement of open fractures and infection. Methods: Searches of the MEDLINE,...

  • Book Review: War Surgery, Field Manual, Second Revised Edition. İnan, Mustafa // Balkan Medical Journal;Jun2012, Vol. 29 Issue 2, p228 

    The article reviews the book "War Surgery: Field Manual," Second Revised Edition, edited by Hans Husum, Swee Chai Ang and Eric Fosse.

  • The Suspension Suture. Salasche, Stuart J.; Jarchow, Robert; Feldman, Bruce D.; Devine-Rust, Mary Joanne; Adnot, John // Journal of Dermatologic Surgery & Oncology;Sep87, Vol. 13 Issue 9, p973 

    The suspension suture is a tension-reducing stitch that anchors the undersurface of a flap or elliptical wound edge to the underlying periosteum. The technique of placing the stitch is described and the indications for and the benefits derived from its use are discussed.

  • Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Reinhold, M.; Knop, C.; Beisse, R.; Audigé, L.; Kandziora, F.; Pizanis, A.; Pranzl, R.; Gercek, E.; Schultheiss, M.; Weckbach, A.; Bühren, V.; Blauth, M. // European Spine Journal;Oct2010, Vol. 19 Issue 10, p1657 

    The second, internet-based multicenter study (MCSII) of the Spine Study Group of the German Association of Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie) is a representative patient collection of acute traumatic thoracolumbar (T1-L5) injuries. The MCSII results are an update of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics