Protocol Guides Wound Closure Timing for Open Fractures

Relies on wound culture results after irrigation and surgical debridement
By Monica Smith
HealthDay Reporter

THURSDAY, Sept. 2 (HealthDay News) -- Use of a protocol based on wound culture results after irrigation and surgical debridement of open fractures appears to result in a low rate of infection and may help guide decisions on wound closure timing, according to research published in the Aug. 18 issue of the Journal of Bone & Joint Surgery.

Christopher J. Lenarz, M.D., of the Saint Louis University School of Medicine, and colleagues evaluated the usefulness of a protocol that delays wound closure following open fractures until negative cultures have been obtained after irrigation and debridement. They evaluated the long-term results of this protocol for 346 open fractures.

The researchers found an overall deep infection rate of 4.3 percent; the rate was 4 percent for Gustilo Type-II fractures and 5.7 percent for Type-III fractures, with variation according to fracture patterns in the latter type. Infection rates were higher in fractures that required multiple debridements and in patients with diabetes or high body mass index. However, for fractures in which the wound was closed after positive cultures were obtained (which was a breach of protocol), there was no significantly increased risk of deep infection (P = 0.0501).

"The use of this standardized protocol was shown to achieve a very low rate of deep infection compared with historical controls. An increased number of irrigation and debridement procedures are required to achieve this improved outcome," the authors write.

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