Keywords
Surgical Debridement; Open Tibia Fracture; Infection; Implant Failure; Nonunion
Abstract
Purpose: The relationship between time to surgical debridement and complications for open tibia fractures remains debatable. The American College of Surgeons guidelines recommend debridement within 24 hours of presentation. However, there are various reasons that debridement may be delayed beyond this due to patient instability from life-threatening injuries. This study evaluates the safety of non emergent debridement of open tibia shaft fractures beyond 12 and 24 hours.
Methods: Patients with open tibia shaft fractures undergoing surgical debridement were retrospectively reviewed. Patient demographics, injury severity, type of fixation, time to antibiotics, Gustilo classification and time to debridement were recorded. Patients were grouped into < 12h, 12-24h, and > 24h cohorts, based on time to debridement. Primary outcomes included rates of infection, tibia nonunion, and implant failure. Univariate analysis and logistic regression were performed.
Results: 66 patients were included in our study, with a median follow-up of 7.5 months (IQR = 4.8-13.5). Mean time-to-debridement was 15 hours ± 11.7. 33 patients (50%) underwent debridement < 12h, 24 patients (36%) between 12-24h, and 9 patients (14%) > 24h. In total, 12 patients (18%) went on to nonunion, 6 patients (9%) had an implant failure, and 14 patients (21%) experienced an infection. Infection, nonunion and implant failure rates did not vary between patients who underwent debridement < 12h (p = 0.22), between 12-24h (p = 0.55), and > 24h (p= 0.89).
Conclusion: In this study, surgical debridement of open tibia fractures 24 hours following presentation was not associated with increased complications. These findings suggest a possibly favorable outcome even for patients who cannot undergo urgent debridement due to medical issues or other traumatic factors.
Citation
Saade A, Tse S, Simister S, Megerian M, Campbell ST, et al. (2024) Timing of Surgical Debridement for Open Tibia Shaft Fractures: How Long Can We Wait?. SM J Orthop 7: 8.