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Violating the 6 hours rule in open hand fractures: How grave a crime is it?
Jignesh V. Unadkat MD, Tim Ng MSII, Ronit Wollstein MD.
University of Pittsburgh Medical Center
2010-03-30
Presenter: Jignesh V. Unadkat
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Hand
Hypothesis: Urgent surgical debridement within 6 hours of injury does not affect incidence of acute infections in open fractures of hand.
Methods: We performed retrospective review of medical records of all patients age12yr to 80yrs with open hand fractures presenting to the emergency department over the last year. All patients received IV antibiotics on arrival to the ED. Data procured was demographics, location of fracture, contamination, interval between injury and time of administration of antibiotics, wash out in ED and time of surgery and occurrence of acute infection. Univariate analysis used to determine distribution of data. Mantel-Haenszel chi-square test used to assess confounding effect of co-morbidities and contamination of fractures.
Results: Preliminary analysis included 46 fractures in 15 consecutive patients. Infection rate was 8.69%(4 out of 46). For fractures debrided in OR within 6hrs, the infection rate was 10%(2 out of 20) and those debrided between 6 and 24hrs, the infection rate was 7.69(2 out of 26)(p= 0.39). For fractures washed in the ED and receiving antibiotics within 6 hrs of injury, infection rate was 0%(0 of 11) and those washed in ED and receiving antibiotics after 6hrs of injury the infection rate was 11.42%(4 of 35)(p=0.03). Co-morbidities and contamination were determined not to be confounding factors affecting infection rate(p=0.78).
Conclusion: Urgent surgical debridement does not influence incidence of acute infection in open hand fractures. However, administering first dose of IV antibiotics and washing out the fracture in ED within 6 hrs of injury does reduce incidence of acute infection.
