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Infection Rates in Open Hand Fractures: Can Treatment Be Delayed?
Mark Tait, MD1; John W. Bracey, MD1; Paulvalery Roulette, MD2, Daniel R Lewis, MD1; Bryan Loeffler, MD1
1OrthoCarolina Hand Center, Charlotte, NC; 2Carolinas Medical Center, Charlotte, NC

Introduction: The purpose of this study was to retrospectively evaluate rates of nonunion and compare the infection rates in two groups of open hand fractures (immediate operative treatment versus delayed operative treatment). We hypothesized that the delayed treatment group would have similar rates of infection and nonunion.

Materials & Methods: A level one trauma center claims database was queried using the International Classification of Diseases (ICD-9) codes for open fractures including both phalanx and metacarpal fractures for patients presenting to the emergency department (ED). Open fractures were treated either with immediate operative treatment or with delayed operative treatment (>24 hours) by a fellowship trained hand surgeon. The groups were then compared as delayed versus immediate treatment groups through a retrospective chart review.

Results: One hundred and twenty nine patients with open hand fractures met the study eligibility criteria. There were 105 males and 24 females with an average age of 42.7 years. Of the 129 open hand fractures, 58 had delayed treatment and 71 received immediate treatment. Follow-up was similar between groups (p=0.74) and, on average, was 6 months (std dev=7.5 months). On average, there was only one phalange or metacarpal fractured, but ranged up to 4 digits involved. Both the delayed and immediate surgical treatment groups had associated soft tissue injuries in 62% of cases (37/58 and 43/71, respectively; p=0.71). The infection rate among those that were delayed was 9% (5 of 58) compared to 14% (10 of 71) that received immediate treatment (p=.34). There were no cases of nonunion in the delayed treatment group, but 9 cases in the immediate treatment group (13%; 9 of 71) (p<0.01). Eighteen (25%) of the immediate treatment group had reoperation, compared to 8 (14%) of the delayed treatment group (p=0.11). When adjusted for severity of injury, the occurrence of a washout in the ER, and the immediate treatment with antibiotics, there was not a statistically significant difference in the rate of infection (OR=0.32, 95% CI: 0.07-1.44; p=0.14) or reoperation (OR=0.50, 95% CI: 0.15-1.63; p=0.25) between groups.

Conclusion: We sought to compare immediate versus delayed operative treatment of patients presenting with open hand fractures. When adjusted for case mix, delayed treatment was associated with lower rates of infection, but the decrease was not statistically significant. Delayed treatment was associated with lower rates of nonunion of open hand fractures when compared to immediate operative treatment.

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