Timing of Debridement in Low-Grade Open Forearm Fractures Does Not Affect Infection Risk: A Retrospective Study

Background: The timing of operative debridement for open upper extremity fractures has not been consistently shown to impact infection rates. Nevertheless, current treatment protocols continue to advocate for prompt surgical debridement in the operating room. We hypothesized that delaying the surgical treatment of low-grade open forearm fractures beyond 24 h from presentation does not increase the likelihood of infection. Methods: The medical charts of patients who presented to a level one trauma center with Gustilo type 1 or 2 open forearm fractures between 2017 and 2020 were retrospectively reviewed. Treatment protocols for these low-grade open fractures included prompt wound irrigation in the emergency department and intravenous antibiotic treatment for 72 h, without emphasizing the timing of surgical intervention. Outcome measures included time to surgery, infection rate, and union rate. Results: The mean ± standard deviation age of the 62-patient cohort was 57 ± 20 years, and 30 (48%) were males. There were 9 proximal third, 16 midshaft, and 37 distal third fractures, of which 41 involved both bones. Forty-eight fractures were classified as Gustilo type 1 and fourteen as Gustilo type 2. Surgery was performed at a median interval of 47 h following presentation, with 43 (69%) patients undergoing surgery later than 24 h following presentation. There was one case (1.6%) of infection and three cases (4.8%) of non-union. Conclusions: Subject to small numbers, our findings suggest that in patients without risk factors, surgical treatment for low-grade open forearm fractures can be safely deferred without an apparent increase in infection rates. Accordingly, treatment protocols for these fractures may prioritize prompt and adequate antibiotic administration over the urgency of surgical intervention.