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Immediate closure of open fracture wounds associated with lower infection rate
Immediate closure of carefully selected open fracture wounds was determined to be safe and was associated with a lower infection rate compared with delayed primary skin closure, according to study results published in The Journal of Bone and Joint Surgery.
Researchers identified 349 Gustilo-Anderson grade I, II or IIIA fractures treated at a level-1 academic trauma center from 2003 to 2007. Eighty-seven wounds were treated with delayed primary closure and 262 were immediately closed after surgical debridement. Researchers analyzed 73 open fractures from each group after applying a propensity score-matching algorithm to balance prognostic factors.
Both treatment groups were compared with respect to the prevalence of infection after adjusting for age, sex, time to debridement, American Society of Anesthesiologists class, fracture grade, evidence of gross contamination and a tibial fracture rather than a fracture at another anatomic site. Overall, researchers found deep infection developed at the sites of three of the 73 fractures (4.1%) treated with immediate closure vs. 13 in the matched group of 73 fractures (17.8%) treated with delayed primary closure.