5. Incidence of Infection after Surgical Management of Open Tibial Shaft Fractures
Abdul Karim1, Malik Asrar Ahmed2 and Zia-ur-Rehman1
ABSTRACT
Objective: To study the incidence of infection after using different methods for fixation of open tibial shaft fractures.
Study Design: Descriptive study
Place and Duration of Study: This study was conducted at the Department of Orthopedic Surgery, Sheikh Khalifa Bin Zayed Al Nahyan Hospital/CMH Rawalakot Azad Kashmir from 5th January 2016 to 5th July 2016.
Materials and Methods: Study was carried out on 62 patients. Patients were included through Non-probability, purposive sampling. Detailed medical history was taken from all the patients and they were examined clinically. Gustilo and Andreson classification was applied on these open factures. All the wounds were swabbed or clinical material from them was collected and sent to laboratory for studying microbiological status. Antibiotics were administered empirically which were revised on the report of culture and sensitivity. Wounds were inspected for signs of infection after 72 hours. In cases of unproven infections, the antibiotics were stopped after three days. The patients were discharged from the hospital after three days depending upon the general condition of the patients and the wounds. All the patients were followed up on 3rd, 7th, 15th, and 30th days, then monthly for six months. The patients were evaluated for the development of infection. Data was collected on a structured questionnaire and analyzed in SPSS software version 16.
Results: The mean age of the patients were recorded as 33.25±14.89years. There were 51 (82.3%) male patients while 11 (17.7%) were female .Open type I was observed in 4 (6.5%) patients ,Type II was noted in 7 (11.3%) cases, IIIA was observed in 43 (69.35%) patients and IIIB was noted in 8(12.9%) cases. In our study, 37 (59.68%) patients were managed with external fixation (EF), while 25 (40.32%) had internal fixation (IF).The cases in which internal fixation was done , DCP was applied in 13 (52%) patients while in 12 (48%) patients ILN was done. Post-debridement wound was left open in 19 (31%) patients and it was closed in 43 (69%) patients primarily. Incidence of infection was more with EF while it was low with IF. In cases of internal fixation ,incidence of infection was more with DCP while it was low with ILN. Infection rate was lower when post-debridement wounds were left open as compared to closing them after debridement.
Conclusion: The rate of post-operative infection was higher in this study with EF as compared to IF (DCP and ILN). Closing the wound after debridement and fixation was associated with higher rate of infection as compared to leaving it open after debridement.
Key Words: Open fracture, post-operative infection, external fixation, internal fixation, open reduction and internal fixation.
Citation of article: Karim A, Ahmed MA, Rehman Z. Incidence of Infection after Surgical Management of Open Tibial Shaft Fractures. Med Forum 2017;28(11):20-23.