Flap coverage reduces infection rates in tibial fractures, Study reports

Kuripla, Casey and colleagues from the Boston University Medical Center, Boston, MA conducted a large, U.S wide, observational study of type III tibial fractures, with the hypothesis that delays between definitive fixation and flap coverage might be a substantial modifiable risk factor associated with nosocomial wound infection.

The researchers carried out a retrospective analysis of a multicenter database of open tibial fractures requiring flap coverage across fourteen level-1 trauma centers across the United States.

Two hundred ninety-six consecutive patients with Gustilo III open tibial fractures requiring flap coverage at 14 trauma centers were retrospectively analyzed from a large orthopaedic trauma registry. The authors collected demographics and the details of surgical care and further investigated the patient, and treatment factors leading to infection, including the time from various points in care to the time of soft-tissue coverage.

Results of multivariate regression with time from injury to coverage, debridement to coverage, and definitive fixation to coverage in the model, to determine which delay measurement was mostly associated with infection was set as the primary outcome. A second multivariate model, including other factors in addition to measures of flap delay, to provide the estimate between delay and infection after adjustment for confounding was laid out.

The study results showed that of 296 adults, 227 were males and 69 were females. The patients with open Gustilo type III tibial fractures requiring flap coverage, 96 (32.4%) became infected. In the multivariate regression, the time from definitive fixation to flap coverage was most predictive of subsequent wound infection (odds ratio 1.04, 95% confidence interval 1.01 to 1.08, n = 260,P = 0.02) among the time measurements.

Furthermore, temporary internal fixation was not associated with an increased risk of infection in both univariate (P = 0.59) or multivariate analyses (P = 0.60). Flap failure was associated with the highest odds of infection (odds ratio 6.83, 95% confidence interval 3.26 to 14.27, P < 0.001).

As a result, it was concluded that coordination of definitive fixation and flap coverage reduce the infection rates in Gustilo type III tibial fractures.

doi: 10.1097/BOT.0000000000002033