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Type III Open Tibia Fractures

Immediate Antibiotic Prophylaxis Minimizes Infection

Lack, William D. MD*; Karunakar, Madhav A. MD; Angerame, Marc R. MD; Seymour, Rachel B. PhD; Sims, Stephen MD; Kellam, James F. MD; Bosse, Michael J. MD

Erratum

In the article that appeared on page 1 of the January 2015 issue of the Journal of Orthopaedic Trauma , a typesetting error occurred regarding the timing reported for patient enrollment. The correct dates patients were treated should have read “between December 1, 2010 and January 31, 2013.”

In addition, the e-mail address listed for the corresponding author is incorrect. The corresponding author’s e-mail address is wlack@lumc.edu .

The publisher regrets these errors.

Journal of Orthopaedic Trauma. 29(6):e213, June 2015.

Journal of Orthopaedic Trauma: January 2015 - Volume 29 - Issue 1 - p 1–6
doi: 10.1097/BOT.0000000000000262
Original Article
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Objective: To examine the association between antibiotic timing and deep infection of type III open tibia fractures.

Design: Retrospective prognostic study.

Setting: Level 1 Trauma Center.

Patients: The study population included 137 patients after exclusions for missing data (13), nonreconstructible limbs (9), and/or absence of 90-day outcome data (3).

Intervention: An observational study of antibiotic timing.

Main Outcome Measurement: Deep infection within 90 days.

Results: Age, smoking, diabetes, injury severity score, type IIIA versus 3B/C injury, and time to surgical debridement were not associated with infection on univariate analysis. Greater than 5 days to wound coverage (P < 0.001) and greater than 66 minutes to antibiotics (P < 0.01) were univariate predictors of infection. Multivariate analysis found wound coverage beyond 5 days [odds ratio, 7.39; 95% confidence interval (CI), 2.33–23.45; P < 0.001] and antibiotics beyond 66 minutes (odds ratio, 3.78; 95% CI, 1.16–12.31; P = 0.03) independently predicted infection. Immediate antibiotics and early coverage limited the infection rate (1 of 36, 2.8%) relative to delay in either factor (6 of 59, 10.2%) or delay in both factors (17 of 42, 40.5%).

Conclusions: Time from injury to antibiotics and to wound coverage independently predict infection of type III open tibia fractures. Both should be achieved as early as possible, with coverage being dependent on the condition of the wound. Given the relatively short therapeutic window for antibiotic prophylaxis (within an hour of injury), prehospital antibiotics may substantially improve outcomes for severe open fractures.

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery, Loyola University Medical Center, Chicago, IL; and

Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC.

Reprints: William D. Lack, MD, Department of Orthopaedic Surgery, Loyola University Medical Center, 2160 S. First Ave. Maywood, IL 60153 (e-mail: wlack@iumc.edu).

The authors report no conflict of interest.

Presented in part at the Annual Meeting of the Orthopaedic Trauma Association, October 15–18, 2014, Tampa, FL.

This study was approved by the Carolinas Medical Center Institutional Review Board with a waiver of regulatory requirements for informed consent.

Accepted November 03, 2014

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