Risk of infection after open fracture of the arm or leg
E. P. Dellinger, S. D. Miller, M. J. Wertz, M. Grypma, B. Droppert and P. A. Anderson
Department of Surgery, Harborview Medical Center, University of Washington, Seattle 98104.
Two hundred forty consecutive patients admitted for operative treatment of
an open fracture of the arm or leg were followed up prospectively for the
development of fracture infection. The independent risk of fracture
infection was increased in patients with grade IIIB or IIIC fractures,
internal or external fixation, lower-leg fracture, any blood transfusion,
or injuries resulting from motorcycle accidents or motor vehicle-pedestrian
accidents. By stepwise multivariate logistic regression, the most
significant risk factors were the grade of the fracture, internal or
external fixation, and fractures of the lower leg. These risk factors all
represent local wound characteristics, and we conclude that the most
important actions by the surgeon to prevent infection involve local wound
care. There was no relation between the timing of antibiotic administration
or duration of antibiotic therapy and infection risk.
