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Comparison of Open and Closed Hand Fractures and the Effect of Urgent Operative Intervention

  • Shobhit V. Minhas
    Correspondence
    Corresponding author: Shobhit V. Minhas, MD, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York University Langone Medical Center, 564 First Avenue, Apt 12U, New York, NY 10016.
    Affiliations
    Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York University Langone Medical Center, New York, NY
    Search for articles by this author
  • Louis W. Catalano III
    Affiliations
    Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York University Langone Medical Center, New York, NY
    Search for articles by this author

      Purpose

      To establish and compare the incidence of 30-day postoperative infection in surgically managed open and closed metacarpal and phalangeal fractures, and to determine whether open fractures treated urgently had a lower incidence of postoperative infection.

      Methods

      We conducted a retrospective analysis of patient demographics, comorbidities, and 30-day infection rates of patients undergoing operative fixation of metacarpal, proximal, or middle phalanx fractures from 2008 to 2015 using the American College of Surgeons’ National Surgical Quality Improvement Program database. A total of 3,506 patients were identified and patient variables and infection incidence were compared between open and closed injuries, as well as open injuries managed within 1 day of admission and those treated on an elective basis or treated more than 1 day after admission. Bivariate analysis was used to determine independent risk factors for postoperative infection.

      Results

      Although 34.2% of open hand fractures were taken urgently to the operating room, the diagnosis of open fractures along with nonurgent surgical treatment for open fractures was associated with a low incidence of postoperative infection. In addition, smoking was a risk factor for postoperative infection although anatomic location (phalanx vs metacarpal) was not.

      Conclusions

      Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone. In addition, patients with open fractures who are taken to the operating room more than 1 day from presentation did not have a higher incidence of infection. Smoking is associated with increased 30-day infection rates after surgery, and surgeons should identify these patients for preoperative risk stratification, counseling, and postoperative wound monitoring.

      Type of study/level of evidence

      Prognostic II.

      Key words

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