Is time to flap coverage of open tibial fractures an independent predictor of flap-related complications?

Objectives: The importance of the timing of flap coverage of open tibial shaft fractures remains controversial. Many studies have shown increased complications and infection rates associated with delay in coverage but have not controlled for risk factors that might be associated with both delay in coverage and complications. We hypothesized that the timing of flap coverage of open tibial fractures is not predictive of complications after controlling for known risk factors.

Design: Retrospective review.

Setting: Level I trauma center.

Patients: Sixty-nine patients treated for acute tibial fractures (45 tibial shaft, 17 plateau, and 12 pilon fractures) at our center from 2004 through 2009 required 74 flaps. Patients requiring flaps later for wound breakdown or infection were excluded.

Intervention: Electronic records and prospective trauma database were reviewed. All fractures were AO classified by a trauma fellowship-trained orthopaedic surgeon.

Main Outcome Measurements: Primary outcome was flap complication, defined as infection or other flap-related adverse outcome requiring surgical treatment. Logistic regression analysis was conducted.

Results: A logistic regression model that separated the first 7 days after injury from subsequent days found no increased risk for days 1 through 7. The odds of complications, and of infection in particular, increased by 11% and 16%, respectively, for each day beyond day 7 (P < 0.04).

Conclusions: Even after controlling for known risk factors for complications, including injury severity, time to flap coverage was a significant predictor of complications.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.