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Risk of Infection After Open Fracture of the Arm or Leg

Risk of Infection After Open Fracture of the Arm or Leg Abstract • Two hundred forty consecutive patients admitted for operative treatment of an open fracture of the arm or leg were followed up prospectively for the development of fracture infection. The independent risk of fracture infection was increased in patients with grade IIIB or IIIC fractures, internal or external fixation, lower-leg fracture, any blood transfusion, or injuries resulting from motorcycle accidents or motor vehicle—pedestrian accidents. By stepwise multivariate logistic regression, the most significant risk factors were the grade of the fracture, internal or external fixation, and fractures of the lower leg. These risk factors all represent local wound characteristics, and we conclude that the most important actions by the surgeon to prevent infection involve local wound care. There was no relation between the timing of antibiotic administration or duration of antibiotic therapy and infection risk. (Arch Surg 1988;123:1320-1327) References 1. Clancey GJ, Hansen ST: Open fractures of the tibia . J Bone Joint Surg 1978;60A:118-122. 2. Chan KM, Leung YK, Cheng JCY, et al: The management of type III open tibial fractures . Injury 1984;16:157-165.Crossref 3. Chapman MW, Mahoney M: The role of early internal fixation in the management of open fractures . Clin Orthop 1979;138:120-131. 4. Heppenstall RB, Brighton CT, Esterhai JL, et al: Prognostic factors in nonunion of the tibia: An evaluation of 185 cases treated with constant direct current . J Trauma 1984;24:790-795.Crossref 5. Gustilo RB, Mendoza RM, Williams DN: Problems in the management of type III (severe) open fractures: A new classification of type III open fractures . J Trauma 1984;24:742-746.Crossref 6. Allgower M, Border JR: Management of open fractures in the multiple trauma patient . World J Surg 1983;7:88-95.Crossref 7. Vander Salm T, Cave EF: Treatment of open fractures , in Cave EF, Burke JP, Boyd RJ (eds): Trauma Management . Chicago, Year Book Medical Publishers Inc, 1974, pp 935-942. 8. Benson DR, Riggins RS, Lawrence RM, et al: Treatment of open fractures: A prospective study . J Trauma 1983;23:25-30.Crossref 9. Roth AL, Fry DE, Polk HC: Infectious morbidity in extremity fractures . J Trauma 1986;26:757-761.Crossref 10. Patzakis MJ, Harvey P Jr, Ivler D: The role of antibiotics in the management of open fractures . J Bone Joint Surg 1974;56A:532-541. 11. Widenfalk B, Ponten B, Karlstrom G: Open fractures of the shaft of the tibia: Analysis of wound and fracture treatment . Injury 1979;11:136-143.Crossref 12. Stone JP, Mears DC, Jarrett J: The management of open and complex fractures of the tibia . Bull NY Acad Med 1980;56:323-339. 13. Johnson KD, Cadambi A, Seibert GB: Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: Effect of early operative stabilization of fractures . J Trauma 1985;25:375-384.Crossref 14. Tscherne H, Oestern HJ, Sturm J: Osteosynthesis of major fractures in polytrauma . World J Surg 1983;7:80-87.Crossref 15. Patzakis MJ, Wilkins J, Moore TM: Considerations in reducing the infection rate in open tibial fractures . Clin Orthop 1983;178:36-41. 16. Gustilo RB, Anderson JT: Prevention of infection in the treatment of 1025 open fractures of long bones . J Bone Joint Surg 1976;58A:453-458. 17. Gustilo RE: Use of antimicrobials in the management of open fractures . Arch Surg 1979;114:805-808.Crossref 18. Dellinger EP, Caplan ES, Weaver LD, et al: Duration of preventive antibiotic administration for open extremity fractures . Arch Surg 1988;123:333-339.Crossref 19. Miller SD, Bray RC, Hughes GNF, et al: Antibiotic treatment of open fractures: A prospective randomized comparison of one day vs five days of cefamandole. Read before the 55th Annual Meeting of the American Academy of Orthopaedic Surgeons, Atlanta, Feb 8, 1988. 20. Teasdale G, Jennett B: Assessment of coma and impaired consciousness: A practical scale . Lancet 1974;2:81-84.Crossref 21. Baker SP, O'Neill B, Haddon W, et al: The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care . J Trauma 1974;14:187-196.Crossref 22. Knaus WA, Draper EA, Wagner DP, et al: APACHE II: A severity of disease classification system . Crit Care Med 1985;13:818-829.Crossref 23. Laduca JN, Bone LL, Seibel RW, et al: Primary open reduction and internal fixation of open fractures . J Trauma 1980;20:580-586.Crossref 24. Riska EB, Bonsdorff H, Hakkinen S, et al: Primary operative fixation of long bone fractures in patients with multiple injuries . J Trauma 1977;17:111-121.Crossref 25. Bone LB, Johnson KD, Weigelt J: Prospective randomized study of femoral fractures: Early vs delayed stabilization and pulmonary insufficiency. Read before the 54th Annual Meeting of the American Academy of Orthopaedic Surgeons, San Francisco, Jan 26, 1987. 26. Muller ME, Allgower M, Schneider R, et al: Manual of Internal Fixation: Techniques Recommended by the AO Group , ed 2. New York, Springer-Verlag NY Inc, 1979. 27. Rittmann WE, Schibli M, Matter P, et al: Open fractures: Long-term results in 200 consecutive cases . Clin Orthop 1979;138:132-140. 28. Dellinger EP, Oreskovich MR, Wertz MJ, et al: Risk of infection following laparotomy for penetrating abdominal injury . Arch Surg 1984;119:20-27.Crossref 29. Nichols RL, Smith JW, Klein DB, et al: Risk of infection after penetrating abdominal trauma . N Engl J Med 1984;311:1065-1070.Crossref 30. Dellinger EP, Wertz MJ, Lennard ES, et al: Efficacy of short-course antibiotic prophylaxis after penetrating intestinal injury: A prospective randomized trial . Arch Surg 1986;121:23-30.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400350034004
Publisher site
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Abstract

Abstract • Two hundred forty consecutive patients admitted for operative treatment of an open fracture of the arm or leg were followed up prospectively for the development of fracture infection. The independent risk of fracture infection was increased in patients with grade IIIB or IIIC fractures, internal or external fixation, lower-leg fracture, any blood transfusion, or injuries resulting from motorcycle accidents or motor vehicle—pedestrian accidents. By stepwise multivariate logistic regression, the most significant risk factors were the grade of the fracture, internal or external fixation, and fractures of the lower leg. These risk factors all represent local wound characteristics, and we conclude that the most important actions by the surgeon to prevent infection involve local wound care. There was no relation between the timing of antibiotic administration or duration of antibiotic therapy and infection risk. (Arch Surg 1988;123:1320-1327) References 1. Clancey GJ, Hansen ST: Open fractures of the tibia . J Bone Joint Surg 1978;60A:118-122. 2. Chan KM, Leung YK, Cheng JCY, et al: The management of type III open tibial fractures . Injury 1984;16:157-165.Crossref 3. Chapman MW, Mahoney M: The role of early internal fixation in the management of open fractures . Clin Orthop 1979;138:120-131. 4. Heppenstall RB, Brighton CT, Esterhai JL, et al: Prognostic factors in nonunion of the tibia: An evaluation of 185 cases treated with constant direct current . J Trauma 1984;24:790-795.Crossref 5. Gustilo RB, Mendoza RM, Williams DN: Problems in the management of type III (severe) open fractures: A new classification of type III open fractures . J Trauma 1984;24:742-746.Crossref 6. Allgower M, Border JR: Management of open fractures in the multiple trauma patient . World J Surg 1983;7:88-95.Crossref 7. Vander Salm T, Cave EF: Treatment of open fractures , in Cave EF, Burke JP, Boyd RJ (eds): Trauma Management . Chicago, Year Book Medical Publishers Inc, 1974, pp 935-942. 8. Benson DR, Riggins RS, Lawrence RM, et al: Treatment of open fractures: A prospective study . J Trauma 1983;23:25-30.Crossref 9. Roth AL, Fry DE, Polk HC: Infectious morbidity in extremity fractures . J Trauma 1986;26:757-761.Crossref 10. Patzakis MJ, Harvey P Jr, Ivler D: The role of antibiotics in the management of open fractures . J Bone Joint Surg 1974;56A:532-541. 11. Widenfalk B, Ponten B, Karlstrom G: Open fractures of the shaft of the tibia: Analysis of wound and fracture treatment . Injury 1979;11:136-143.Crossref 12. Stone JP, Mears DC, Jarrett J: The management of open and complex fractures of the tibia . Bull NY Acad Med 1980;56:323-339. 13. Johnson KD, Cadambi A, Seibert GB: Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: Effect of early operative stabilization of fractures . J Trauma 1985;25:375-384.Crossref 14. Tscherne H, Oestern HJ, Sturm J: Osteosynthesis of major fractures in polytrauma . World J Surg 1983;7:80-87.Crossref 15. Patzakis MJ, Wilkins J, Moore TM: Considerations in reducing the infection rate in open tibial fractures . Clin Orthop 1983;178:36-41. 16. Gustilo RB, Anderson JT: Prevention of infection in the treatment of 1025 open fractures of long bones . J Bone Joint Surg 1976;58A:453-458. 17. Gustilo RE: Use of antimicrobials in the management of open fractures . Arch Surg 1979;114:805-808.Crossref 18. Dellinger EP, Caplan ES, Weaver LD, et al: Duration of preventive antibiotic administration for open extremity fractures . Arch Surg 1988;123:333-339.Crossref 19. Miller SD, Bray RC, Hughes GNF, et al: Antibiotic treatment of open fractures: A prospective randomized comparison of one day vs five days of cefamandole. Read before the 55th Annual Meeting of the American Academy of Orthopaedic Surgeons, Atlanta, Feb 8, 1988. 20. Teasdale G, Jennett B: Assessment of coma and impaired consciousness: A practical scale . Lancet 1974;2:81-84.Crossref 21. Baker SP, O'Neill B, Haddon W, et al: The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care . J Trauma 1974;14:187-196.Crossref 22. Knaus WA, Draper EA, Wagner DP, et al: APACHE II: A severity of disease classification system . Crit Care Med 1985;13:818-829.Crossref 23. Laduca JN, Bone LL, Seibel RW, et al: Primary open reduction and internal fixation of open fractures . J Trauma 1980;20:580-586.Crossref 24. Riska EB, Bonsdorff H, Hakkinen S, et al: Primary operative fixation of long bone fractures in patients with multiple injuries . J Trauma 1977;17:111-121.Crossref 25. Bone LB, Johnson KD, Weigelt J: Prospective randomized study of femoral fractures: Early vs delayed stabilization and pulmonary insufficiency. Read before the 54th Annual Meeting of the American Academy of Orthopaedic Surgeons, San Francisco, Jan 26, 1987. 26. Muller ME, Allgower M, Schneider R, et al: Manual of Internal Fixation: Techniques Recommended by the AO Group , ed 2. New York, Springer-Verlag NY Inc, 1979. 27. Rittmann WE, Schibli M, Matter P, et al: Open fractures: Long-term results in 200 consecutive cases . Clin Orthop 1979;138:132-140. 28. Dellinger EP, Oreskovich MR, Wertz MJ, et al: Risk of infection following laparotomy for penetrating abdominal injury . Arch Surg 1984;119:20-27.Crossref 29. Nichols RL, Smith JW, Klein DB, et al: Risk of infection after penetrating abdominal trauma . N Engl J Med 1984;311:1065-1070.Crossref 30. Dellinger EP, Wertz MJ, Lennard ES, et al: Efficacy of short-course antibiotic prophylaxis after penetrating intestinal injury: A prospective randomized trial . Arch Surg 1986;121:23-30.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1988

References