The effect of time to theatre on infection rate for open tibia fractures

Open tibia fractures are an orthopaedic emergency. Surgical intervention has traditionally been recommended within 6 h of injury to decrease the risk of infection. There is little support for this time frame in published works, with no prospective randomized controlled trials to date. We sought to determine whether delay to definitive treatment affected the infection rate in open fractures of the tibia at our institution. A retrospective review of 161 consecutive skeletally mature patients with open tibia fractures treated at Liverpool Hospital was carried out. Cases were reviewed using the department database and the medical records. Time between injury and surgery was recorded as 0-6, 6-12 or 12-24 h. The infection rate was calculated for each group, and statistical significance was calculated using the chi(2)-test. No increase in the infection rate was found with increasing time to theatre, as five of the six infections occurred in the 0 to 6-h group, and no infection occurred when treatment was delayed by more than 12 h. The infection rate was found to correlate with the grade of the open injury. The infection rate after open tibia fractures is strongly associated with the grade of the open fracture rather than the time to initial surgery. It may be justified to delay surgery on open tibia fractures until an optimal operating environment can be provided.