Management of Open Tibial Shaft Fractures: Does the Timing of Surgery Affect Outcomes?

Background: Open tibial shaft fractures require emergent care. Treatment with intravenous antibiotics and fracture debridement within 6 to 24 hours is recommended. Few studies have examined outcomes when surgical treatment is performed >24 hours after occurrence of the fracture. Methods: This retrospective study included 227 patients aged 18 years with isolated open tibial shaft fractures in whom the time to initial debridement was >24 hours. The statistical analysis was based on time from injury to surgical debridement, Gustilo-Anderson classification, method of fixation, union status, and infection status. Results: Fractures debrided within 24 to 48 hours and 48 to 96 hours after injury did not show a statistically significant difference in terms of infection rates (P = 0.984). External fixation showed significantly greater infection rates (P = 0.044) and nonunion rates (P = 0.001) compared with intramedullary nailing. Conclusion: Open tibial shaft fractures should be debrided within 24 hours after injury. Our data indicate that after the 24-hour period and up to 4 days, the risk of infection remains relatively constant independent of the time to debridement. Patients treated with external fixation had more complications than did patients treated with other methods of fixation. Primary reamed intramedullary nailing appears to be a reasonable option for the management of Gustilo-Anderson types 1 and 2 open tibial shaft fractures.