Time to surgical debridement in open long bone fractures of the lower limb and its effect on union and infections: A prospective cohort study

Christina Marie, Joseph (2018) Time to surgical debridement in open long bone fractures of the lower limb and its effect on union and infections: A prospective cohort study. Masters thesis, Christian Medical College, Vellore.

[img]
Preview
Text
220201118christina_marie_joseph.pdf

Download (4MB) | Preview
[img]
Preview
Text
220201118christina_marie_joseph_abstract.pdf

Download (257kB) | Preview

Abstract

OBJECTIVES: To study the effect of time to surgical debridement on non-union, infection rates and patient quality of life in open long bone lower limb fractures. METHODS: 182 patients with 206 open long bone lower extremity fractures were recruited in a prospective cohort study from October 20th 2015 to October 20th 2016 with a follow-up rate of 93%. The cohort was empirically divided into 2 groups (early and late) based on the time to debridement (less or more than 12 hours from injury). Non-union was evaluated at 9 months. Infection rates, additional surgeries, in-patient bills and functional outcomes in both groups were also recorded. Data was entered using Microsoft Excel 2016 and analysed using independent 2 sample t tests, chi square tests, univariate and multivariate analysis. RESULTS: 169 patients with 198 fractures were evaluated at 9 months. The non-union and infection rates were 33.5 and 35.6% respectively. Non-union was associated with late debridement (OR 5.89: 95% CI, 1.72-20.3). There was a 6 % increase in the infection risk for each hour of surgical delay (OR 1.06: 95% CI, 1.02- 1.07). No significant difference was observed in additional surgeries performed and treatment costs in both groups. However, the early group had a superior functional outcome, 83.3% patients returned to work compared to 34.7% in the late group. CONCLUSION: Our study conclusively proves that debridement in open fractures should be done as soon as possible. This is particularly of importance in developing countries which bear the brunt of trauma. Formulating protocols for early wound management may be beneficial in saving life, limb and money.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Time to debridement ; Non-union ; infections ; open fractures ; lower limb ; functional outcome.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Jul 2018 03:43
Last Modified: 14 Jul 2018 03:43
URI: http://repository-tnmgrmu.ac.in/id/eprint/8763

Actions (login required)

View Item View Item