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J Am Acad Orthop Surg, Vol 16, No 7, July 2008, 369-375.
© 2008 the American Academy of Orthopaedic Surgeons
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The Urgency of Surgical Débridement in the Management of Open Fractures

Clément M. L. Werner, MD, PD Dr med, Yvonne Pierpont, MD and Andrew N. Pollak, MD

Dr. Werner is Attending, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. Ms. Pierpont is Resident, University of South Florida, Tampa, FL. Dr. Pollak is Associate Professor and Head, Division of Orthopaedic Traumatology, University of Maryland School of Medicine, Baltimore, MD.

Perspectives on Modern Orthopaedics articles provide an objective appraisal of new or controversial techniques or areas of investigation in orthopaedic surgery.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Werner, Dr. Pierpont, and Dr. Pollak.

Reprint requests: Dr. Pollak, University of Maryland School of Medicine, Room 3TR54, 22 South Greene Street, Baltimore, MD 21201-1544.

Emergent débridement of open fractures within 6 hours of injury has long been considered to be critical to prevention of infection. The basis for this mandate is unclear, however. In clinical practice, physiologic and logistical challenges frequently limit the degree to which such emergent surgical care can effectively be rendered. Furthermore, concerns exist that quality of care might be improved when services are performed during normal working hours. The current literature suggests no obvious advantage to performing surgical débridement within 6 hours after injury versus doing so between 6 and 24 hours after injury. The effect of delays >24 hours is unclear. Further research in this area would be helpful, but development of definitive level I evidence seems unlikely. Surgical débridement of open fractures should be accomplished urgently, as soon as the patient’s physiologic condition permits and as soon as appropriate resources are available to safely perform the procedure. 






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Copyright © 2008 by the American Academy of Orthopaedic Surgeons.