Higher Reoperation Rates in Planned, Staged Treatment of Open Fractures Compared with Fix-and-Close: A Propensity...

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Infectious Disease

Background:

• Surgical management for open fractures (Gustilo-Anderson type I-IIIA) varies, with decisions often based on contamination and fracture severity.
• Traditional approaches include immediate closure (fix-and-close) or staged fracture and wound management.

Purpose of the Study:

• To compare surgical site infection (SSI) rates, wound complications, nonunion, and 1-year reoperation rates between fix-and-close and planned, staged treatment for type I to IIIA open fractures.

Main Methods:

• Secondary analysis of Aqueous-PREP and PREPARE-Open study participants with type I-IIIA open fractures.
• Propensity score matching was used to compare fix-and-close versus planned, staged treatment groups.
• Outcomes analyzed included deep SSI, wound complications, nonunion, and reoperation rates.

Main Results:

• In a matched cohort of 1,672 patients, staged treatment was linked to higher odds of deep SSI within 90 days (OR 2.0) and infection-related reoperation within 1 year (OR 1.47).
• No significant difference was found in wound dehiscence, necrosis, healing failure, flap coverage reoperation, or nonunion rates between the groups.
• Fix-and-close treatment showed decreased odds of deep SSI and infection-related reoperation without increased risks of other complications.

Conclusions:

• Fix-and-close treatment for type IIIA and lower open fractures is associated with fewer deep SSIs and infection-related reoperations within one year.
• This approach may be considered for open fractures, even with contamination, if adequate debridement is performed.
• Fix-and-close treatment offers comparable safety regarding wound complications and nonunion rates compared to staged management.