Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures  

作　　者：Riya Savla Yen-Hong Kuo Nasim Ahmed 

机构地区：[1]Department of Surgery and Trauma,Hackensack Meridian School of Medicine,Nutley,NJ 07110,United States [2]Department of Medical Sciences,Hackensack Meridian School of medicine,Nutley,NJ 08753,United States [3]Office of Research Administration,Hackensack Meridian Health Research Institute,Nutley,NJ 077110,United States [4]Department of Surgery,Department of Trauma and Surgical Critical Care,Jersey Shore University Medical Center,Neptune,NJ 07754,United States [5]Department of Surgery,Department of Trauma and Surgical Critical Care,Hackensack Meridian School of Medicine,Nutley,NJ 07110,United States

出　　处：《World Journal of Orthopedics》2024年第6期539-546,共8页世界骨科杂志（英文版）

摘　　要：BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.

关 键 词：Pediatric trauma Open tibia fracture Irrigation and debridement Timing of intervention Surgical site infection 

分 类 号：R726.8[医药卫生—儿科]