Open Fractures in Polytrauma and Non-Polytrauma Patients: Outcomes and Predictive Factors in a Level III Trauma Center.

Abstract

Purpose of the study: Open fractures represent complex injuries characterized by bone exposure, soft-tissue damage, and a high risk of infection, often requiring multidisciplinary management. In polytraumatized patients, these injuries further increase clinical complexity and hospital resource utilization. The purpose of this study was to evaluate adherence to international guidelines in the management of open fractures at a third-level trauma center and to identify clinical and organizational predictors of outcomes, complications, and hospitalization burden in polytraumatized and non-polytraumatized patients.

Material and methods: A retrospective, single-center study was conducted including all patients treated for open fractures between January 2020 and December 2023. Demographic data, injury mechanisms, fracture location, Gustilo-Anderson grade, surgical timing, treatment strategy (Early Total Care or Damage Control Orthopedics), ICU admission, complications, and readmissions were collected. Polytrauma status was recorded. Primary outcomes included infection rate, length of hospital stay, number of admissions, and cumulative hospitalization time. Statistical analysis was performed using Student's t-test, Fisher's exact test, and Pearson correlation, with significance set at p < 0.05.

Results: A total of 115 patients were included, of whom 53 (46.1%) were polytraumatized. The mean age was 47.1 years, with a male predominance. Lower-limb fractures were most common, particularly involving the tibia. Grade III injuries accounted for 61.7% of cases. Surgical debridement was performed within 6 hours in 65.2% of patients. External fixation for damage control was used in 73% of cases, with a mean fixation duration of 103 days. Postoperative ICU admission was required in 27.8% of patients. Overall infection rate was 15.7%. Polytraumatized patients experienced significantly longer hospital stays and a higher number of readmissions, but polytrauma status was not associated with increased infection risk. Higher Gustilo-Anderson grade showed a strong correlation with prolonged hospitalization and infection. Damage control strategies were associated with longer cumulative hospitalization and more frequent readmissions but not with higher infection rates.

Discussion: These findings indicate that fracture severity and local tissue damage, rather than polytrauma status itself, are the main determinants of infection risk and hospitalization burden. While polytrauma increases overall resource utilization, standardized multidisciplinary management allows comparable orthopedic outcomes. Damage control orthopedics remains essential in severe cases but implies longer and more fragmented care pathways.

Conclusions: In a high-volume trauma center adhering to international guidelines, open fracture outcomes are primarily driven by injury severity. Polytrauma influences hospitalization burden but not infection risk. Awareness of these factors is essential for optimizing trauma pathways, resource allocation, and patient counseling.