Open fractures associated with earthquakes and high-energy trauma: Clinical outcomes and management strategies.

backgroundThis study aimed to evaluate the epidemiological characteristics, infection rates, complication risks, and clinical management strategies of open fractures resulting from high-energy traumas. Special attention was given to the effects of the 2023 major earthquake on the incidence of open fractures and patient management, comparing different trauma mechanisms retrospectively.

methodsThis retrospective study included 512 patients admitted to a tertiary trauma center between 2019 and 2024. Patients were classified according to five different trauma mechanisms: traffic accidents, falls from height, occupational injuries, gunshot wounds, and earthquake-related traumas. Open fractures were assessed and classified using the Gustilo-Anderson classification to determine the severity of the injuries. Treatment protocols included early antibiotic administration, surgical debridement, wound management protocols, and surgical fixation methods. Statistical analyses were performed to compare differences between early surgical intervention (within 24 hours) and delayed surgical intervention (after 24 hours). Statistical tests used included T-test, Mann-Whitney U test, Chi-square test, and logistic regression analysis. A p-value of <0.05 was considered statistically significant.

resultsThe mean age of the 512 patients was 37.4+-12.6 years, with 68% males and 32% females. The most common trauma mechanism was traffic accidents (54.2%), followed by falls from height (27.8%), occupational injuries (12.5%), gunshot wounds (5.5%), and earthquake-related traumas (11.3%). A significant proportion of earthquake-related injuries were classified as Gustilo-Anderson Type III fractures (42.8%), which was notably higher than that of other trauma mechanisms (p<0.001). In earthquake-related cases, multiple fractures were present in 63.2% of patients, and bilateral extremity fractures were observed in 21.4% of cases. The infection rate was 11.4% in patients who received early antibiotic administration, compared to 27.8% in those with delayed administration (p<0.005). Early surgical intervention resulted in an infection rate of 15.2%, whereas delayed intervention showed an infection rate of 31.4% (p=0.002). Amputation rates were found to be 6.4% for the entire patient group, but 41.2% in the Gustilo-Anderson Type IIIC fracture group. Osteomyelitis rate was 18.6% in patients who underwent delayed wound closure, and 35% of these patients required prolonged intravenous antibiotic therapy.

conclusionThis study demonstrates that early antibiotic administration, early surgical intervention, and appropriate wound management strategies significantly reduce infection rates in open fractures resulting from high-energy traumas. Particularly, the high complication rates observed in earthquake-related cases highlight the need for systematic and carefully planned approaches in disaster-related patient management. The findings emphasize the importance of optimal surgical timing and proper antibiotic protocols in reducing infection risks and improving clinical outcomes. Further prospective studies are needed to validate these findings.