Functional Outcome of Open Tibial Fractures with Delayed Wound Debridement Beyond 6 Hours: A Prospective Observational Study from a Tertiary Care Hospital in India

Abstract

Background: Early wound debridement, traditionally within 6 hours, is a cornerstone of open fracture care, but in many resource-limited settings it is rarely achievable. We assessed wound healing and functional outcome in adults with open tibial fractures debrided more than 6 hours after injury and compared those debrided within 24 hours with those debrided later.

Methods: This prospective observational study at a tertiary care hospital (November 2022 to November 2024) included adults with open tibial fractures who presented and underwent debridement more than 6 hours after injury. Patients were grouped as debrided ≤24 h or >24 h from injury. Outcomes were wound culture, infection, wound healing, radiographic union (RUST score), complications, number of procedures, and Johner–Wruhs functional grade. Groups were compared with Fisher’s exact, Welch’s t and Mann–Whitney U tests.

Results: Forty-two patients were enrolled (92.9% male; 83.3% road traffic accidents; Gustilo–Anderson type II most common, 42.9%). Mean injury-to-debridement time was 86.1 hours; 11 patients (26.2%) were debrided within 24 hours and 31 (73.8%) later. Wound cultures were positive in 19 patients (45.2%, 95% CI 31.2–60.0); MRSA was the most frequent isolate (7.1%). Infection occurred in 45.5% of the ≤24 h group and 45.2% of the >24 h group (p = 1.00). Of 33 patients with a Johner–Wruhs grade, 66.7% were excellent or good, 30.3% fair and 3.0% poor; the grade distribution did not differ significantly between groups (p = 0.09). Union was achieved in 15 of 17 patients with at least 6 months of follow-up. Split-skin grafting was more frequent in the ≤24 h group (36.4% vs 6.5%, p = 0.03). Eight patients (19.0%) were lost to follow-up or died.

Conclusion: Infection was common in late-presenting open tibial fractures, but no significant difference in infection, union or functional grade was detected between debridement within and after 24 hours. The small sample, attrition and short follow-up limit inference; larger multicentre studies that adjust for injury severity are needed.