Strategies in Trauma and Limb Reconstruction

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VOLUME 11 , ISSUE 1 ( April, 2016 ) > List of Articles

Original Article

Factors influencing infection in 10 years of battlefield open tibia fractures

J. G. Penn-Barwell, P. M. Bennett, D. E. Mortiboy, C. A. Fries, A. F. G. Groom, I. D. Sargeant

Keywords : Combat, War, Injuries and wounds, Open fracture, Tibia, Infection, Limb salvage, Military

Citation Information : Penn-Barwell JG, Bennett PM, Mortiboy DE, Fries CA, Groom AF, Sargeant ID. Factors influencing infection in 10 years of battlefield open tibia fractures. 2016; 11 (1):13-18.

DOI: 10.1007/s11751-016-0250-x

License: CC BY-NC-SA 4.0

Published Online: 01-12-2013

Copyright Statement:  Copyright © 2016; The Author(s).


The aim of this study was to characterise severe open tibial shaft fractures sustained by the UK military personnel over 10 years of combat in Iraq and Afghanistan. The UK military Joint Theatre Trauma Registry was searched for all such injuries, and clinical records were reviewed for all patients. One hundred Gustilo–Anderson III tibia fractures in 89 patients were identified in the 10 year study period; the majority sustained injuries through explosive weapons (63, 68 %) with the remainder being injured from gunshot wounds. Three fractures were not followed up for 12 months and were therefore excluded. Twenty-two (23 %) of the remaining 97 tibial fractures were complicated by infection, with S. aureus being the causative agent in 13/22 infected fractures (59 %). Neither injury severity, mechanism, the use of an external fixator, the need for vascularised tissue transfer nor smoking status was associated with subsequent infection. Bone loss was significantly associated with subsequent infection (p < 0.0001, Fisher's exact test). This study presents 10 years of open tibial fractures sustained in Iraq and Afghanistan. Most infection in combat open tibia fractures is caused by familiar organisms, i.e. S. aureus. While the overall severity of a casualty's injuries was not associated with infection, the degree of bone loss from the fracture was.

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