Risk of infection and conversion time from external to definitive fixation in open tibial fracture

An open fracture of the tibia is one of the most common and dangerous type of open fractures. In the management of these injuries, the primary focus is on reducing the infection rate, as this is crucial for achieving the best clinical outcomes. This study aims to explore how provisional external fixation duration influences the rates of infection and union in open tibial shaft fractures.

A retrospective study with a total of 55 patients who received temporary external fixation. Groups A (less than 12 days), B (12-24), C (25-36), and D (more than 36) were the four groups into which they were split according to the conversion time.

12.8%, 18.2%, 50%, and 100% of the infections were found in Groups A, B, C, and D, respectively. Significant (P < 0.05) differences were found throughout the four groups. The conversion time from external to definitive fixation was found to have a relationship with the occurrence of an infection (P = 0.004). A higher prevalence of infection was observed over time. However, no association was observed between infection and antibiotic duration or initial debridement time (P = 0.689 and P = 0.963, respectively).

Results of this study demonstrate that the likelihood of infection increases when the change from external fixation to definitive internal fixation is delayed. Therefore, it is important to convert to definitive internal fixation immediately when the local and general conditions are favorable for doing so.