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J Am Acad Orthop Surg, Vol 10, No 6, November/December 2002, 379-384.
© 2002 the American Academy of Orthopaedic Surgeons
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Timing of Closure of Open Fractures

Amanda D. Weitz-Marshall, MD and Michael J. Bosse, MD

Dr. Weitz-Marshall is Resident, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC. Dr. Bosse is Director, Clinical Research, Carolinas Medical Center, Charlotte.

Traditionally, closure of open fractures after initial débridement has been delayed to minimize the risk of complications, particularly infection. This practice developed before the widespread use of systemic antibiotics, local antibiotic bead pouches, advanced débridement methods, and improved fracture stabilization techniques. Current evidence indicates that infections after treatment of open fractures frequently are not caused by initial contaminating organisms but often are acquired in the hospital. Recent studies comparing primary with delayed closure have not demonstrated an increased rate of complications. Considering the improvements in open fracture wound care, the increasing incidence of resistant nosocomial infections, and the cost implications of a dogmatic delayed-closure strategy, wound care protocols for open fractures should be reevaluated. Because of lack of data specifically addressing the timing of closure of such wounds, studies comparing primary versus delayed closure are needed.




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Copyright © 2002 by the American Academy of Orthopaedic Surgeons.