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Timing of Débridement of Open Fractures

Dr. Pollak is Associate Professor of Orthopaedics, University of Maryland School of Medicine, and Attending Orthopaedic Traumatologist, R Adams Cowley Shock Trauma Center, Baltimore, MD.

Dr. Pollak or the department with which he is affiliated has received research or institutional support from Synthes, Wyeth, and Stryker. Dr. Pollak or the department with which he is affiliated has received royalties from Jones and Bartlett Publishers.

Although débridement within 6 to 8 hours of injury seems nearly universally accepted, the data supporting this recommendation are lacking. Most studies indicate that, in the context of modern antibiotic treatment, early débridement is not an independent predictor of decreased risk of infection. Achieving early débridement may pose unjustified risks to patient safety. Given the numerous factors that influence timing of surgical débridement in trauma centers, a prospective randomized trial of emergent versus urgent débridement is not feasible. However, a prospective longitudinal study could yield valuable data.

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