Retrospective analysis of risk factors for deep infection in lower limb Gustilo-Anderson type III fractures.
Abstract | BACKGROUND: MATERIALS AND METHODS: This retrospective study investigated patients who underwent surgical procedures for lower limb G-A type III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G-A type III fractures (77 G-A type IIIA fractures and 37 G-A type IIIB fractures) who were followed up for at least 2 years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G-A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure. RESULTS: Eighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (P < 0.01), G-A classification (P < 0.01), duration of antibiotic prophylaxis (P < 0.01), timing of wound closure (P < 0.01), and incidence of soft-tissue reconstruction failure (P < 0.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (P = 0.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (P < 0.01). CONCLUSION: Early flaps rather than skin grafting should be used to cover G-A type IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures. LEVEL OF EVIDENCE: Level IV retrospective observational study.
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Authors | Taku Ukai, Kosuke Hamahashi, Yoshiyasu Uchiyama, Yuka Kobayashi, Masahiko Watanabe |
Journal | Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
(J Orthop Traumatol)
Vol. 21
Issue 1
Pg. 10
(Jul 18 2020)
ISSN: 1590-9999 [Electronic] Italy |
PMID | 32683562
(Publication Type: Journal Article, Observational Study)
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Chemical References |
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents
(administration & dosage, therapeutic use)
- Antibiotic Prophylaxis
- Debridement
- Female
- Fracture Fixation, Internal
(methods)
- Fractures, Open
(complications, drug therapy, surgery)
- Humans
- Lower Extremity
(injuries, microbiology, surgery)
- Male
- Middle Aged
- Osteomyelitis
(etiology, prevention & control, therapy)
- Plastic Surgery Procedures
(methods)
- Retrospective Studies
- Risk Factors
- Soft Tissue Infections
(diagnosis, etiology, microbiology, therapy)
- Soft Tissue Injuries
(complications, therapy)
- Surgical Flaps
- Surgical Wound Infection
(diagnosis, etiology, prevention & control, therapy)
- Tibial Fractures
(drug therapy, microbiology, surgery)
- Treatment Outcome
- Young Adult
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