TIME TO THEATRE AND INFECTION

The time for definitive treatment of open long-bone fractures by tradition and for many years has been arbitrarily set at less than 6 h to minimize infection, to obtain primary union and to maximize soft tissue healing. Where the figure of 6 h arose appears lost in orthopaedic folklore as there is no scientific basis or documented clinical research to support this. It appears to have arisen around the time of the Vietnam war in the early 1970s and until recently has been accepted. Indeed, time to theatre in less than 6 h for open long-bone fractures is still a clinical indicator for the statistics gathered by the NSW Trauma Committee. In recent years, however, the timing to definitive treatment has been questioned and other factors such as the severity of the injury, according to the Gustilo and Anderson classification, and experience and availability of surgical and nursing staff have been evaluated. It is appropriate, therefore, that this article by Sungaran et al. should examine the time to definitive treatment in a busy trauma unit in the Australian setting. Although there is growing concern about hospital-acquired infections and the development of multiresistant organisms, there is no doubt that the appropriate use of high-dose intravenous antibiotics at the time of presentation of an open fracture has had an important beneficial effect on the rate of infection. Other factors to be considered in the timing of the operative procedure include the surgeon’s experience, possible fatigue, availability and experience of anaesthetic staff, availability of the most appropriate implant, experience and availability of a radiographer and the experience of nursing staff. In places other than major trauma centres, the scrub nurse maybe junior, inexperienced or often agency staff, unfamiliar with the type of fixation; this can be compounded by a junior radiographer on call, leading to prolongation of the operative procedure and potentially deleterious effect on the outcome.2 The conclusion of the authors that delaying surgical treatment in patients with open fractures until the optimum operating environment can be provided is justified by their statistical analysis and is supported by other papers, which they quote by Harley from Canada,3Charalambous4 as well as similar conclusions being reached by Skaggs from The Childrens Hospital in Los Angeles.5 The overall infection rate in these open fractures of the tibia in the Liverpool Hospital Group of 3.7% compares favourably with other papers published and as noted relates directly to the severity (grade 3) of the injury. Definitive treatment of open long-bone fractures within 6 h should therefore be relegated to orthopaedic history and no longer regarded as a benchmark of satisfactory treatment.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.