A systematic review of early versus delayed wound closure in patients with open fractures requiring flap coverage
Bibliographic record
Abstract
BACKGROUND: Wound management in open fractures remains an area of controversy. Although numerous protocols for soft tissue coverage and fracture fixation have been proposed, problems with infection, delayed healing, and prolonged disability have remained. The purpose of this systematic review was to critically examine the timing of flap coverage in open fractures and its impact on bone union, infections, complication rates, and duration of hospital stay. METHODS: We comprehensively searched the literature for relevant studies across CINAHL, EMBASE, MEDLINE, and the Cochrane databases. The Orthopaedic Trauma Association and Canadian Orthopedic Association proceedings were also searched. Two independent reviewers screened and assessed abstracts. Articles were selected using specific inclusion criteria and were categorized as "early," "intermediate," or "late" based on their timing of flap coverage. Methodological quality of included studies was assessed using the Newcastle-Ottawa Scale for Cohort Studies. RESULTS: Of 83 potentially eligible studies, 20 articles were included in the final analysis (agreement kappa = 0.83). Of these, eight studies evaluated "early" flap coverage, nine studies evaluated "intermediate" flap coverage, and nine studies evaluated "late" flap coverage. Early flap coverage was associated with lower infection rates (p < 0.0001) and lower complications (p = 0.15). CONCLUSIONS: The results of this systematic review (level III evidence) suggest that any delay in flap coverage may provide suboptimal bone healing, infection, and complication rates. It is recommended that methodologically sound randomized controlled trials be performed comparing "early" flap coverage time points to determine optimal outcomes for bone union, infection, and hospital stay as none exist to date.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".