Comparison of early versus delayed debridement in open fractures
Abstract
Objective: Open fracture, a disruption of soft tissue and exposure of fractured bone to surrounding environment is a high risk condition for infection and is recommended to treat it by irrigation, surgical debridement and antibiotic therapy as soon as possible. Since the role of each of the above mentioned factors and the interval between admission and debridement is still in debate, the present study was designed to determine the difference between early and delayed debridement in open fracture and its effect on infection occurrence. Infected fracture was defined by either clinical evidence of infection or positive wound culture.
Methodology: A prospective, double blind study was performed on 379 patients with 381 open fractures. Location of fracture, interval (time between the injury and debridement) and Gustilo or Duncan classifications of open fractures were recorded. For all patients irrigation and antibiotic therapy was started with standard protocol. Early (less than 6 hours) and delayed (more than 6 hours after injury) debridements were done in group A with 289 and group B with 92 patients, respectively and all patients were followed up for early infection (onset within the 10 days after injury).
Results: Seven patients (2.4%) in group A and 4.3% (4 of 92) in group B had early infection and this difference was not significant (p=0.34).
Conclusion: The result of early and delayed debridement is almost the same in open fractures, if patients receive suitable antibiotic therapy.
Methodology: A prospective, double blind study was performed on 379 patients with 381 open fractures. Location of fracture, interval (time between the injury and debridement) and Gustilo or Duncan classifications of open fractures were recorded. For all patients irrigation and antibiotic therapy was started with standard protocol. Early (less than 6 hours) and delayed (more than 6 hours after injury) debridements were done in group A with 289 and group B with 92 patients, respectively and all patients were followed up for early infection (onset within the 10 days after injury).
Results: Seven patients (2.4%) in group A and 4.3% (4 of 92) in group B had early infection and this difference was not significant (p=0.34).
Conclusion: The result of early and delayed debridement is almost the same in open fractures, if patients receive suitable antibiotic therapy.
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