Complications of open fractures: Observational study over 4 years, search for risk factors for infection.

Abstract

Background: Open fractures account for approximately 2.6% of all fractures but continue to pose a significant clinical challenge due to their associated complications and potential impact on limb function. Among these complications, infection remains particularly prevalent. Although numerous recent studies have addressed this issue, many are limited by restrictive inclusion criteria, especially regarding the anatomical segments of the limbs evaluated HYPOTHESIS: We hypothesized that recent advances in open fracture management may have impacted infection rates across the entire appendicular and pelvic skeleton, and may have altered the associated risk factors compared to historical data.

Materials and methods: We conducted a retrospective, single-center, observational study including 368 open fractures treated at our institution between January 2017 and December 2020, with a minimum follow-up of one year. The primary outcome was the incidence of secondary infection. Secondary outcomes included the occurrence of other complications, the need for surgical reinterventions, and the time required for bone and soft tissue healing.

Results: A secondary infection occurred in 13.3% of cases. The most frequently isolated pathogens were Staphylococcus spp. and Enterobacter cloacae. Identified risk factors included bone loss, crush injuries, and pelvic trauma. The presence of secondary infection was significantly associated with a higher number of reinterventions, increased complication rates, and prolonged skin healing time (p < 0.05).

Discussion: The 13.3% secondary infection rate observed aligns with existing literature but exceeds recent reports limited to tibial fractures. Our broader anatomical scope revealed higher infection risks in ankle and pelvic fractures. Known risk factors (diabetes, high Gustilo grade, crush injuries) were confirmed, while emerging associations (high BMI, bone loss, pelvic/ankle location) warrant prospective validation. A surprising correlation between prolonged prophylaxis and infection likely reflects confounding by indication. The underuse of SFAR-recommended regimens-despite frequent isolation of amoxicillin-clavulanate-resistant Enterobacter-underscores the need to reassess prophylactic strategies. Study limitations include retrospective design and potential selection bias, but robust follow-up and comprehensive data support the clinical relevance of our findings.

Level of evidence: IV; retrospective study.