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Published on: February 2, 2024
Risk Factors Associated With Infection in Open Fractures of the Upper and Lower Extremities.
Paul Tornetta1, Gregory J Della Rocca, Saam Morshed
1From the Department of Orthopedic Surgery, Boston Medical Center, Boston, MA (Dr. Tornetta III); the University of Missouri School of Medicine, Columbia, MO (Dr. Della Rocca); the University of California San Francisco, San Francisco General Hospital, Orthopaedic Trauma Institute, San Francisco, CA (Dr. Morshed); the The CORE Institute, University of Arizona-Phoenix, Phoenix, AZ (Dr. Jones); the Department of Health Research Methods, Evidence, and Impact (Ms. Heels-Ansdell, Dr. Sprague, and Dr. Bhandari) and the Division of Orthopaedic Surgery, Department of Surgery (Dr. Sprague, Dr. Petrisor, Ms. Del Fabbro, Ms. Bzovsky, and Dr. Bhandari), McMaster University, Hamilton, Ontario, Canada; and the Department of Orthopaedic Surgery, Prisma Health-Upstate, Greenville, SC (Dr. Jeray).
Open fracture infections are linked to tibia location, severe contamination, and flap coverage needs. Understanding these risk factors aids in patient counseling and prognosis for open fracture wound care.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Trauma Care
Background:
- Open fractures carry a significant risk of infection, making prevention a primary concern in perioperative management.
- Effective infection control is crucial for optimizing outcomes in patients with open fracture wounds.
Purpose of the Study:
- To identify factors associated with infection development in patients with open fractures.
- To enhance understanding of prognosis and patient counseling regarding infection risk.
Main Methods:
- Multivariable analysis of data from 2,500 participants in the Fluid Lavage of Open Wounds trial.
- Cox proportional hazards regression used to determine factors associated with infection up to 12 months post-fracture.
Main Results:
- Tibia fracture location (HR 5.13), low energy injury (HR 1.64), severe wound contamination (HR 2.12), and need for flap coverage (HR 1.82) were significantly associated with infection.
- Specific hazard ratios and confidence intervals were calculated for each identified risk factor.
Conclusions:
- Fracture location, injury energy, wound contamination severity, and surgical intervention (flap coverage) are key predictors of infection in open fractures.
- This research provides valuable insights for surgeons to counsel patients on their individual infection risk and prognosis.
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