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Infectious morbidity in extremity fractures.

A I Roth, D E Fry, H C Polk

    The Journal of Trauma
    |August 1, 1986
    PubMed
    Summary

    Infections in open extremity fractures are often hospital-acquired and resistant to antibiotics. Preventive antibiotics are ineffective for open fractures but beneficial for closed fractures undergoing open reduction and internal fixation (ORIF).

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    Area of Science:

    • Orthopedic Surgery
    • Infectious Disease Epidemiology

    Background:

    • Infectious morbidity is a significant concern in extremity fracture management.
    • Open fractures carry a higher risk of infection compared to closed fractures.

    Purpose of the Study:

    • To review and compare infectious morbidity in open versus closed extremity fractures.
    • To evaluate the efficacy of preventive preoperative antibiotics in reducing infection rates for both fracture types.

    Main Methods:

    • Retrospective review of 265 patients with 280 open fractures and 573 patients with closed fractures requiring open reduction and internal fixation (ORIF).
    • Analysis of infection rates, causative organisms, and antibiotic resistance patterns.
    • Comparison of infection rates between groups receiving and not receiving preoperative antibiotics.

    Main Results:

    • Open fractures had an 11% infection rate, with significantly fewer infections in gunshot-induced fractures and upper extremity fractures.
    • Preventive preoperative antibiotics did not reduce infection rates in open fractures; infections were often caused by resistant, hospital-acquired organisms.
    • Closed fractures had a 3% infection rate after ORIF, and preoperative antibiotics significantly reduced this rate.
    • Staphylococci were the predominant pathogens in ORIF patients.

    Conclusions:

    • Preventive antibiotics are effective for reducing infections in closed fractures undergoing ORIF but not for open fractures.
    • Hospital-acquired pathogens resistant to antibiotics are a major factor in open fracture infections, suggesting post-injury contamination is critical.
    • Strategies to prevent hospital-acquired infections are crucial for managing open extremity fractures.

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