Postoperative Infections Following Open Tibia Fractures: A Retrospective Study Evaluating Incidence and Prognostic Factors at a Major Trauma Centre.

Background Open fractures are common, high-risk injuries in which the fracture site communicates with the external environment, predisposing patients to postoperative fracture-related infection (FRI). These infections can lead to prolonged hospital stay, additional surgery and long-term morbidity.  Objectives To determine the incidence of FRI following open tibia fractures at a single major trauma centre and explore potential prognostic factors, including timing of antibiotic administration, timing of initial debridement, and definitive skeletal and soft-tissue management.  Methodology This was a five-year retrospective observational study at a UK major trauma centre. Adult patients (≥18 years) with open tibia fractures within the inclusion period were identified from trauma meeting records and electronic patient records. Patients who received their initial management at other hospitals were excluded. Data collected included patient demographics, injury characteristics, timing of antibiotic administration, timing and type of operative fixation, soft-tissue management and occurrence of postoperative infection.  Results A total of 440 patients with open tibia fractures presented during the study period; 340 met the inclusion criteria and were analysed. Postoperative infection occurred in 33/340 cases (9.7%). The mean age of infected patients was 45 years, and most were male. Intravenous antibiotics were administered within three hours of injury in 32/33 (97%) infected cases. Overall, 9/33 (27%) infections were superficial, and 13/33 (39%) were deep, with seven patients requiring further procedures for removal of metalwork.  Conclusions In this single-centre cohort, postoperative FRI occurred in approximately one in 10 patients with open tibia fractures. Earlier administration of antibiotics, timely initial debridement and primary soft-tissue closure were associated with lower observed infection rates and may represent key targets for optimisation of care pathways.