Relationship Between Time to Surgical Debridement and the Incidence of Infection in Patients with Open Tibial Fractures

OBJECTIVE: To analyze the relationship between the length from injury to first debridement (LFITFD) of open tibial fractures and perioperative infection, and explore independent risk factors related to infection. METHODS: This retrospective study focused on 215 clinical patients with open tibial fractures who were admitted from January 2012 to January 2017. According to the time from injury to the operation, the patients were categorized into four groups: LFITFD ≤ 6 h, 6 < LFITFD ≤ 12 h, 12 < LFITFD≤24 h, and (LFITFD > 24 h). Infection risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors. RESULTS: The infection rates of four groups were 9.2%, 9.5%, 11.1%, and 10.5% with six of 65, nine of 95, four of 36, and two of 19 patients being infected, respectively. There was no statistical significance between the four groups. The infection rates among fractures of different Gustilo–Anderson classifications were as follows. Of 62 cases of type I fractures, two were infected, and the infection rate was 3.2%. Among those with type II fractures, eight were infected, and the infection rate was 8.2%. Three of 26 cases of type IIIA fracture were infected, yielding an infection rate of 11.5%, seven of 25 cases of type III B fracture were infected (28% infection rate), and one of four cases of type III C fracture was infected (25% infection rate). There was a statistically significant difference between the five groups. Multivariate regression analysis showed that smoking, combined diabetes, surgical time, and fracture Gustilo–Anderson classification were independent risk factors for perioperative infection of open tibial fractures, and the difference in time from injury to first debridement was not related to infection. CONCLUSION: The incidence of perioperative infection in patients with open tibial fractures has little to do with the time of the first debridement, which is mainly related to the level of the fracture's Gustilo–Anderson classification. At the same time, smoking is prohibited before the operation, the patient's blood glucose is managed, and the debridement operation time is minimized conducive to reducing the incidence of infection.