Study Examines Use of Defined Surgical Approach for Open Fracture Débridement

Study results indicate that use of a defined surgical approach for the débridement of open tibia fractures is a safe alternative to direct extension of the traumatic wound and may result in a decreased need for return to the operating room and soft-tissue coverage procedures. The data are presented in Scientific Poster P512, on display in Academy Hall.

The authors note that wound extension during surgical débridement of open fractures may prevent closure and result in the need for flap coverage, particularly with wounds over the medial face of the tibia. They add that although a defined surgical approach that does not disturb the traumatic wound may minimize soft-tissue–associated complications, the safety and efficacy of this approach has not been documented.

The study involved 68 open fractures treated at a single institution over a 13-month period; fractures with an Orthopaedic Trauma Association (OTA) skin score of III were excluded. The method of débridement used—extension of the traumatic wound (Direct; n = 47) or use of a separate defined approach (Defined; n = 21)—was at the treating surgeon’s discretion. The anterolateral approach to the tibia was used for all cases in the Defined group.

Patients underwent fracture fixation with either medullary nailing, internal fixation, or external fixation. Primary wound closures were performed when possible during the index procedure; noncloseable wounds were treated with negative pressure wound therapy or an antibiotic-impregnated bead pouch. Traumatic wounds were treated with subsequent débridement until they were either amenable to primary closure or soft-tissue coverage was performed.

Using statistical analysis, the researchers found no differences between the two débridement groups in mean OTA fracture score, mean number of trips to the operating room (O.R.), and the number of patients requiring soft-tissue flap coverage.

One deep infection that necessitated a return trip to the O.R. and one superficial infection that resolved with oral antibiotics occurred in each group.

The authors conclude that a defined surgical approach for the débridement of open tibia fractures is a safe alternative to direct extension of the traumatic wound. They recommend orthopaedic surgeons consider using the defined surgical approach for débridement of open tibia fractures with wounds whose extension may prevent closure and that may require additional procedures for coverage.           

Authors of Poster P512, “The Defined Surgical Approach in the Débridement of Open Tibia Fractures: A Safe Alternative” are Luke Nicholson, MD; Geoffrey Marecek, MD; and Richard Lawrence Auran.

Details of the authors’ disclosure as submitted to the Orthopaedic Disclosure Program can be found in the Final Program; the most current disclosure information may be accessed electronically at