Association between time to initial surgical debridement and development of non-unions in open long bone fractures of the lower limb: A prospective cohort study

Abstract

Objectives: The aim of the present study was to evaluate the association between time to initial surgical debridement and development of non-unions (assessed at 9 months) and infections in open long bone fractures of the lower limb. Methods: This was a prospective cohort study conducted over a period of one year between June 2020 and May 2021 at the department of Orthopaedics, in a tertiary healthcare facility in central India. Results: The present study included a total of 88 patients and 100 fractures. The mean (SD) age of the patients was 40.6 years (11.2) and road traffic accidents were the most common mechanism of injury (94.3%), followed by crush injuries (3.4%), and fall (2.3%). Fracture of the tibia and/or fibula was noted in 74.0% and 26.0% patients had fracture of the femur. The median (IQR) ASA scores were 1 (1 to 5) and ISS scores were 11 (6 to 34). The median (IQR) time to debridement was 14.9 hours (4.7 to 148) and the time to antibiotics was 11.3 hours (2.7 to 102.1). 38.0% of the fractures had deep infection. The proportion of fractures with non-union were 63.0%. The results showed that shorter the duration of time to debridement, better the rates of fracture union; deep infections were associated with significantly increased rates of non-union; levels of CRP more than 6mg/dl is associated with increased risk of fracture non-union (p<0.05). The non-union group had significantly poor functionality in comparison with the union group; patients from non-union group had poor quality of life in comparison with patients from union group (p<0.05). Conclusion: The findings advocate for a comprehensive and patient-centered approach to fracture management, acknowledging the intricate interplay between timely surgical intervention, complications, and the long-term well-being of affected individuals.