Deep infection and Gustilo grade associated with open fracture nonunion

SAN DIEGO — Deep infection and higher Gustilo grade fractures were strongly associated with the development of open fracture nonunions or delayed healing, according to a presenter, here.

“Time to initial surgical debridement did not appear to impact the development of deep infection or nonunion in open fractures,” Don Weber, MD, said in his presentation. “However, having said that, unnecessary delay to the operating room is not recommended.”

Weber and colleagues assessed time since fracture, patient age and gender, the presence of infection, grade of injury and its location and patient smoking status in 736 patients (72% men; average age 41 years) with 791 open fractures of which 94% were included in the study.

The cause of these injuries included motor vehicle accidents (49%), falls (30%), crush injuries (18%) and assaults (2%).

“Fracture location, as to be expected from this patient population, was largely tibia and fibular fractures,” Weber said.

Mean time to treatment in the operating room was 11 hours; 55% of patients were treated at 6 hours to 12 hours post-injury, and 28% of patients were treated outside of 12 hours, he noted.

The results showed the unadjusted rate for nonunion was 17% nonunion rate, according to study results.

“Looking at unadjusted values, the highest grades of nonunion were in the femur, the higher grade Gustilo injuries and most significant, the deep infections,” Weber said. “The infection presence had a 12-fold increase in the presentation of nonunion, also increase in Gustilo grade and the presence of smoking.” – by Casey Tingle

Reference:

Weber D, et al. Paper #54. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 7-10, 2015; San Diego.

Disclosure: Weber reports no relevant financial disclosures.