Effect of delay of surgical treatment on rate of infection in open fractures in children

This study reviews all open fractures treated at a tertiary children's hosp ital from 1990 to 1995 to determine whether delaying surgical debridement i nfluences the rate of infection in the pediatric population. One hundred fo ur open fractures were followed until both clinical and radiographic union was evident. A 1.0% rate of infection requiring surgical drainage, and a 1. 0% rate of soft-tissue infection managed with oral antibiotics alone was fo und. Infection rates for fractures treated within 6 h of injury was 2.5%, a nd for fractures treated with >6 h delay was 1.6%. No significant statistic al difference in infection rate with delay in surgical debridement was foun d (p = 0.77). Delays of 5 and 16 h were found in the two fractures complica ted by infection, compared with an average delay of 12 h for those that hea led uneventfully. Our findings suggest that in children,given early parente ral antibiotics, operative irrigation and debridement may be delayed >6 h w ithout an increased risk of infection. As this series contains only 18 pati ents with grade III open fractures and nine patients whose surgery was dela yed >24 h, conclusions should not be made in these groups.