Open tibia XXXX : timely debridement leaves injury severity as the only determinant of poor outcome.

@entity1 @entity174 @entity281 @entity1230 @entity130
BACKGROUND: Recent retrospective studies suggest that the time to debridement of open tibia @entity174 is not a major determinant of outcome. The aim of this prospective study was to determine the modifiable independent predictors of poor outcomes. METHODS: A 36-month prospective observational study ending in December 2009 was performed on consecutive open tibia shaft @entity174 @entity1 (age >18 years) admitted to a Level 1 @entity130 center. Demographics, mechanism, Injury Severity Score, @entity174 type/grade, local contamination, time to debridement, time to antibiotics, and interventions were prospectively recorded. Outcome measures were as follows: length of stay, @entity281 , secondary procedures, and presence of union at 6 months and 12 months. Univariate, multivariate, and logistic regression analyses were performed. RESULTS: Eighty-nine consecutive @entity1 (74% male, age 41 years  17 years, Injury Severity Score 15  3, and 37% multiple injured) met inclusion criteria. The mean time to surgical debridement and operative stabilization was 8 hours  4 hours (48% within 6 hours). The average length of stay was 21 days  13 days. Fifteen @entity1 (17%) had @entity281 and 5 (6%) required amputation (1 acute and 4 late because of the @entity281 ). The 6-month and 12-month union rates were 39% and 67%, respectively. Fifty-six @entity1 (63%) required further procedures (a total of 312). The multivariate regression model (18 variables) showed no independent significant predictors for @entity281 or nonunion at 6 months and 12 months ( @entity1230 and smoking were closest to reach significance, p=0.08). CONCLUSION: Timely management of open tibia @entity174 (mean, 8 hours) eliminates time to debridement and contamination as predictors of poor outcome. @entity1 factors and local and @entity130 severity determine the outcomes. Aiming for the earliest safe time to debridement minimizes the negative effects of modifiable factors on the outcome.
