Open tibial fractures: risk factors for infection in conversion of external fixator to intramedullary nail at a tertiary academic hospital

摘要

Aim: To determine the rate of infection in open tibial fractures treated by conversion of an external fixation into an intramedullary nail, andto identify the factors contributing to the infections.Methods: The study included a total of 52 patients. Multiple variables were assessed as risk factors that could lead to infection in opentibial fractures treated primarily with an external fixator and later converted into an intramedullary nail. The factors looked at were: age,average time taken from injury to debridement, average time taken from admission to debridement, antibiotics administration, facility thatadmitted the patient before intramedullary nail, average time for conversion of external fixator into intramedullary nail insertion, type ofsoft tissue management, initial Gustilo and Anderson classification and retrospective re-classification of fractures, existence of superficialsepsis or pin-tract infection, radiologic evidence of infection, the Injury Severity Score and the type of external fixator used. A p value0.05).Conclusion: The study suggests that correct classification of open tibial fractures, with recognition of soft tissue injury and bonecomminution, is important in reducing infection rates and in ensuring proper initial management of these fractures. Treatment should bebased on the classification done in theatre during the initial debridement, rather than on presentation in the trauma unit.