Primary Wound Closure After Open Fracture: A Prospective Cohort Study Examining Nonunion and Deep Infection. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Scharfenberger, Angela V.; Alabassi, Khaled; Smith, Stephanie; Weber, Donald; Dulai, Sukhdeep K.; Bergman, Joseph W.; Beaupre, Lauren A.
• Is Part Of: Journal of orthopaedic trauma. Volume 31:Issue 3(2017)
• Publication Date: 2017-03
• Subjects: open fracture -- wound management -- deep infection -- nonunion; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000751
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: Determine the proportion of subjects developing deep infection or nonunion after primary wound closure of open fractures (humerus, radius/ulna, femur, and tibia/fibula). Secondarily, a matched-series analysis compared outcomes with subjects who underwent delayed wound closure. Design: Prospective cohort between 2009 and 2013 of subjects undergoing primary closure. Setting: Trauma center. Participants: Eighty-three (84 fractures) subjects were enrolled. Eighty-two (99%) subjects (83 fractures) provided follow-up data. Matching (age, sec, fracture location, and grade) was performed using study data of delayed wound closure undertaken at the same center between 2001 and 2009 (n = 68 matched subjects). Intervention: Primary wound closure occurred when the fracture grade was Gustilo grade 3A or lower and the wound deemed clean at initial surgery. Standardized evaluations occurred until the fracture(s) healed; phone interviews and chart reviews were also undertaken at 1 year. Main Outcome Measurements: Deep infection is defined as infection requiring unplanned surgical debridement and/or sustained antibiotic therapy after wound closure; nonunion is defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing 1-year after fracture. Results: Three (4%) subjects had deep infections, whereas 10 (12%) subjects developed nonunion in the primary closure cohort. In the matched analyses [n = 68 pairs; (136 subjects)], the primary closure cohort had fewer deep infections [n = 3 (4%) vs. n = 6 (9%)] and nonunions [n = 9 (13%) vs. n = 19 (29%)] than the delayed closure cohort ( P < 0.001). Conclusions: Primary wound closure after an open fracture appears acceptable in appropriately selected patients and may reduce the risk of deep infection and nonunion compared with delayed closure; a definitive randomized trial is needed. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.