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Immediate wound closure reduces infection risk after debridement of open fracture
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Immediate wound closure after surgical debridement decreased the rate of infection in patients with Gustilo-Anderson grade-I, II or IIIA open fractures.
“Immediate closure of carefully selected wounds by experienced surgeons treating grade I, II or IIIA open fractures is safe and is associated with a lower infection rate compared with delayed primary closure,” the authors wrote in the abstract.
In the propensity-matched cohort study, researchers compared 87 open fractures treated with surgical debridement followed by immediate wound closure to 262 open fractures that received the same surgery, but had delayed primary wound closure. After the researchers used a prospensity score-matching algorithm, they compared a group of 73 open fractures that were closed immediately after surgical debridement to 73 open fractures treated with surgical debridement and delayed primary wound closure. The researchers obtained patient data from their institution’s trauma database from between January 1, 2003 and January 1, 2007. The propensity score matched groups had similar fracture grades, gross contamination and tibial fractures.
There was a 3.4% infection rate in the immediate wound closure group compared to 18.4% in the delayed wound closure group. After the propensity score matched analysis, the researchers found a 4.1% infection rate in the immediate closure group compared to 17.8% in the delayed closure group.
“This finding suggests an absolute risk reduction of 13.7% for development of deep infection for the primary-closure group,” the authors wrote in the study. “Primary closure may be preferable for carefully selected low-grade injuries. Patients must be monitored closely, regardless of closure type, in order to assess for a surgical-site infection and to institute timely treatment.” — by Renee Blisard Buddle
Disclosures: Jenkinson is employed by Sunnybrooke Health Sciences Center and receives grants from the Canadian Orthopaedic Trauma Society and Orthopaedic Trauma Association. Johnson and Kiss have no relevant financial disclosures. Kreder is an AO Foundation trustee, receives grants from the Canadian Institutes of Health Research, PSI and the Canadian Orthopaedic Trauma Society and receives institutional support from Biomet, Synthes and Zimmer. Stephen is a consultant and receives payment for lectures from Synthes.
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