Open fractures

Summary

There is conflicting evidence from three retrospective cohort studies regarding infection and nonunion rates when comparing primary with delayed wound closure in open fractures. One study of open tibial fractures suggests that delayed, secondary closure may result in a significant decrease in nonunion and infections compared with primary closure. These findings were not replicated in two other studies, however. Comparisons across studies were difficult as different types of fractures and fixation methods were included in each study. In addition, distribution of fracture types and fixation methods may have differed between primary and delayed closure groups. Methodologically rigorous comparative studies which control for confounding factors (eg, injury severity, fracture type and grade, fixation method) are needed to determine whether there are real differences in outcomes between primary and delayed wound closure.