The Relationship Between Debridement Time And Infection Rate In Open Tibial Fractures

Objective: Along with the development of the social,the morbidity of open fractures caused by high energy also has been a rising trend.If open fractures poorly treated,and will become the most intractable diseases in the field of trauma: osteomyelitis,bone nonunion.Scholars at home and abroad have been made a lot of clinical explore on the relationship between open fractures and morbidity of infection.Such as :the etiology of open fractures,the classification of open fractures,the degree of soft tissue damage,the time to debridement,the ways of debridement,how to treatment the fractures.The main focus on the relationship between the infection rate and the debridement time.In open fractures,the incidence of open tibial fractures was high and had a high infection rate.Open tibial fractures had brought a heavy burden for patients,families and the community.The purpose of this paper was to investigate the relationship between time from the injury to the initial surgical management and the infection rate in open tibial fracture.Methods: Most people thought that open fractures must be definitive surgical management within six hours.They argued that more than six hours to debridement can increase the infection rate.In fact,most injured patients cannot be arrived at the hospital in time due to a variety of reasons,so they unable to debridement within 6 hours.But there is no increase about the infection.So we made a prospective study.We collected mature patients with open tibial fractures were treated between January 1,2016 and March 1,2017.They were came from the Third Hospital of Hebei Medical University trauma emergency center(Exclusion criteria: With other parts of the open fractures;Multiple injuries(ISS score greater than 16 points);Combination of malignant tumor;Combination of joint deformity;Accompanied by chronic diseases such as heart,brain,liver and kidney;Cannot determine the time ofinjury to the debridement).Patients were divided into A,B two groups by the time from the injury to the initial surgical management.Group A was injured to enter operating room debridement within 6 hours,group B was more than 6 hours.We selected patient's sex,age,fracture type(Gustilo type),the time of start debridement,whether or nor infection etc for statistical analysis by the SPSS version 21.0 Statistical Software Package,to investigate the relationship between time to definitive surgical management and the infection rate in open tibial fracture.(In the event,we will check the C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR),Secretion culture,positive for infection,the recessive for non-sepsis).If the measurement data conforms to normal distribution and variance,We used the mean ±SD(X ±s)said measurement data and two independent samples t test.The differences of proportions between groups were tested by the chi-squared test or Fisher's exact test if the total number of cases less than 40 or expectations of a lattice < 5.If the p < 0.05,we think the difference was statistically significant.Results: A total of 39 patients(27 male,12 female,maximum 82 years,minimum 10 years,mean age 40.05±16.38 years)with open tibial fractures(24 cases on the left side,19 cases on the right side)randomly collected between January 1,2016 and March 1,2017,with 43 cases of open tibial fractures.28 cases of traffic accident,6 cases of falling injury,crush injury 1 case,knife cuts 2 cases,other 6 cases.Shin,middle and under section for 4,12,27 cases respectively.According to the Gustilo-Anderson classification: type ?,type ?,type ?A,type ?B,type ?C has 1 case,18 cases,8 cases,10 cases,6 cases,respectively.Two patients with type ?C were amputated.A total of 15 cases of infection,the infection rate were 34.9%.Bacterial culture of type were staphylococcus aureus(4 cases),acinetobacter baumannii(3 cases),klebsiella pneumonia(2 cases),staphylococcus haemolyticus(2 cases),coagulase negative staphylococcus aureus(2 cases),1 cases of e.coli,1 case of enterobacter cloacae.Group A :maximum 69 years,minimum 10 years,mean age 41.00±17.27 years;Group B: maximum82 years,minimum 14 years,mean age 39.48±16.13 years.There was no statistical significance between the two groups about ages(T=0.291,P>0.05).According to the Gustilo-Anderson classification,Group A: type?,type?,type? has 1 cases,5 cases,10 cases,respectively,Group B: type?,type?,type? has 0 cases,13 cases,14 cases,respectively.There was no statistical significance between the two groups about type(Fisher=2.750,P>0.05).Infections occurred in 6 of 16 patients for group A,the infection rate was 37.5%.infection in 9 of 27 cases for Group B,the rate of infection was33.3%.There was no statistical significance between the two groups about the infection rate(?2=0.077,P>0.05).The infection rate was 11.1%,54.2%for Type? and type?,respectively.There was statistically difference between fracture classification and the infection rate(?2=8.305,P<0.05),the infection rate of Type ? is greater than the Type?.Conclusion: The results showed that the time to definitive treatment more than six hours does not increase the risk of infection in open tibial fracture,the serious damage decrement is an important factor for open tibial fracture whether infection after debridement.