Podium (General) 22

The Prevalence of Infection In Open Long Bone Fractures And Its Association To The Timing Of Debridement Among Patients In Jose R. Reyes Memorial Medical Center: A Retrospective And Cross-Sectional Analytical Study

Paolo M. Ramirez, MD
Marlon Rommel P. Narbarte, MD
Alvin N. Enriquez, MD, FPOA
Jose R. Reyes Memorial Medical Center

IRB No. 2020-080 

Aim: Most open fractures that require debridement in Jose R. Reyes Memorial Medical Center are usually done more than 48 hours post injury, which is way

beyond the recommended “6-hour rule” to decrease the risk of developing infection. The goal of this study is to methodically review the association between

time to operative debridement of open long bone fractures and infection in our institution.

Methods: This study used a retrospective, single-center, cross-sectional analytic design to determine the association of infection and the timing of debridement for patients with open long-bone fractures.All patients (206) with open long bone

fractures who underwent debridement from January 2017 - December 2019 were included in this study using purposive sampling technique. Medical records from

JRRMMC data base was used for data collection. STATA 13.1 was used for data analysis.

Results: The multivariate analysis on the association of the different variables with infection among patients with open long-bone fractures showed that age, comorbidities, higher Gustilo-Anderson type, long bone affected (tibia and fibula) and timing of wound debridement were significantly associated with infection. The risk for infection increases by 0.98 times for every increase in age (OR=0.98; 95% CI: 0.96 – 0.99; p=0.003). The risk of patients with comorbidities for infection was 2x higher than those without comorbidities (OR=2.29; 95% CI=1.24 –4.23;p=0.008). For the Gustilo-Anderson type, those with Type II or IIIA classification had 4-times higher risk for infection than those with Type IIIB or IIIC classification (OR=4.41; 95% CI=1.83 – 10.61; p=0.001). The risk of patients with tibia or fibula affected bone was almost 5-times higher than those with other affected long bone (OR=4.76; 95% CI=2.45 – 9.25; p<0.001) and for timing of wound debridement, those with >24 hours timing had almost 3-times higher risk for infection than those with timing <24 hours (OR=2.82; 95% CI=1.92 – 4.14; p<0.001).

Conclusion: The current study aimed to provide evidence on the significance of early debridement and the rate of infection after open fracture of long bones. Although there is still controversy surrounding the 6-h rule and whether delayed debridement is a significant risk factor in the development of infections in open fractures, the basic principles of open fracture management still stands. Early debridement should be completed as soon as possible, and timing of antibiotic administration should be even earlier than that (ideally within 3 hours of injury). In settings where a delay in timing of debridement is inevitable, it is prudent to monitor the status of the patient before and after formal debridement with appropriate dressing changes and culture-guided antibiotic therapy in order to limit the rates of infection in open fractures.