Infection Rate by Gustilo-Anderson Classification in Open Tibial Shaft Fractures Treated with an Intramedullary Nail...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Epidemiology
• Trauma Care

Background:

• Open tibial shaft fractures are complex injuries requiring surgical intervention.
• Intramedullary nailing is a common treatment, but carries a risk of deep surgical site infection (SSI).
• The Gustilo-Anderson (G-A) classification system stratifies open fracture severity and may correlate with SSI risk.

Purpose of the Study:

• To quantify deep SSI rates following intramedullary nailing of open tibial shaft fractures.
• To stratify these infection rates based on the Gustilo-Anderson (G-A) classification.
• To assess the relationship between fracture severity and deep SSI risk.

Main Methods:

• Systematic review of MEDLINE, Embase, and Scopus (2000-2025) following PRISMA guidelines.
• Included skeletally mature patients with open tibial shaft fractures (OTA/AO 42) treated with intramedullary nailing.
• Single-arm meta-analysis of pooled deep SSI rates, stratified by G-A classification, using fixed and random-effects models.

Main Results:

• Seventeen studies with 2,063 patients were included.
• Overall pooled deep SSI rate was 13.2%.
• Infection rates increased with G-A severity: G-A I (6.2%), II (7.6%), IIIA (11.9%), IIIB (25.0%), IIIC (41.8%). Significant differences across classifications (P < 0.001).

Conclusions:

• Deep SSI rates significantly increase with Gustilo-Anderson severity in open tibial shaft fractures treated with intramedullary nailing.
• High-grade injuries (G-A IIIB and IIIC) are associated with a substantial risk of fracture-related infection.
• Severity stratification is crucial for understanding and managing infection risk in these complex fractures.