Open fractures: it doesn't come out in the wash

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Wound Complications

Background:

• The 6-hour timeframe for washout in open traumatic fractures is considered standard care.
• Rural Level I trauma centers face challenges with timely patient transport, leading to variable washout times.
• This study investigates the relationship between fracture severity and timing of washout on orthopedic complications.

Purpose of the Study:

• To determine if orthopedic complications after open fractures are associated with fracture severity or the time elapsed before surgical washout.
• To evaluate the impact of various injury parameters on complication rates.

Main Methods:

• Retrospective review of 1,487 open fractures in 1,278 patients over 6.3 years.
• Data collected included demographics, injury severity scores (Injury Severity Score, Abbreviated Injury Score [AIS], Revised Trauma Score [RTS]), fracture grade (Gustilo), location, mechanism, and time to washout.
• Logistic regression analysis was used to compare orthopedic wound complication rates.

Main Results:

• Overall complication rate was 8.2%, increasing with fracture severity (Injury Severity Score, AIS, Gustilo class) and blunt trauma.
• Time to washout was not significantly related to complication rates, particularly for penetrating injuries.
• Multivariable analysis identified fracture grade, RTS, and male gender as independent predictors of complications; penetrating trauma was associated with lower risk.

Conclusions:

• Initial injury severity and patient physiology (RTS) are key predictors of orthopedic wound complications.
• Time to washout was not an independent predictor, suggesting limited benefit for strict adherence in certain cases (e.g., Gustilo grade 1/AIS 1, penetrating injuries).
• Focus should be on initial injury assessment rather than solely on the timing of washout for managing open fractures.