Authors: Jonathan J. Linthicum MD, Joseph M. Bowen MD, John Schlecter DO, Montri D. Wongworawat MD
Title: Factors Associated with Acute Infection in Open Fractures-Preliminary Results
Addresses: Department of Orthopaedic Surgery, Loma Linda University East Campus, 11406 Loma Linda Drive, Suite 218, Loma Linda, CA 92354
Purpose: The purpose of this study was to prospectively investigate what factors predict acute infection in open fractures. We present our preliminary findings.
Methods: A prospective study following all open fractures in patients admitted to three regional trauma centers was performed between July 1, 2005 and December 31, 2005. Continuous variables included, age, BMI, GCS, amount of irrigation in the ER, time from injury to antibiotics, duration of antibiotics, time from injury to formal irrigation, debridement, and fixation, and time from injury to second surgery. Categorical variables are fracture grade, intubated status, cephalosporin use, aminoglycoside use, penicillin use, clindamycin use, Fixation type, presence of drain, and location of fracture (divided into hand and not hand). Acute infection was defined as infection occurring within the first 14 days following injury. The Mann-Whitney test was used for continuous variables while the Fisher exact test was applied to the categorical variables. Statistical significance was set at p-value of less than 0.05. A logistic regression model was applied.
Results: 306 cases were enrolled in the study, 104 of which were lost to follow up leaving 202 cases in 175 patients. Between the infected group and the uninfected group there were no statistically significant differences in all variables. See Table 1 for continuous variables and Table 2 for categorical variables. Figures 1 and 2 depict number of infected and nonifected cases categorized by Gustillo Type and time to surgery. Logistic regression did not yield meaningful results due to the small number of cases.
Discussion: Time from injury to surgery did not correlate with rate of infection. Of note was that the average times from injury to surgery in the non-infected and infected groups were 18.57 hours and 19.15 hours, respectively (p = 0.242). No other factors showed a significant association with acute infection. Greater numbers of patients will be obtained as the study continues.