| ObjectiveThe open fractures’ infection rate is much higher than close fracture and orthopeadic infections are likly to end up with a catastrophic functional and cosmetic outcomes. Since the investigate of open fracture has been greatly developed these years, a standard primaty management has been widely accepted. Early debridement and external fixation will be well executed quikly when an open fracture’s patient been transfer into a hospital. After the primary management, when should the patient receive a delayed internal fixation surgery? There is no clear. criteria about it.The aim of this study is to find out a criterion to solve those problem through a retrospective study.MethodsA retrospective analysis of the 40 open fractures’ patient treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from August 1,2008 to Mar 1,2015. All these cases are treated by stages, which means they all acceped a primary debridement and external fixation initialy and received a delayed internal fixation after a few days. the preoperative factors which may ralated to infection were recored, which include preoperate body pemperature/leucocyte count/neutrophilic granulocyte count and neutrophil proportion, CRP and PCT and so on. All these factors were analized by SPSS 16.0 software. These factors which contribute more than others will draw a ROC curve to clarify the best scope with low infection rate.Result6 cases occurred with postoperative infection among 40 cases. C-reactive protein and the timing of delayed surgery show statistically significant relationship with postoperative infection(P<0.05), while other factors did not have(P> 0.05).C-reactive protein showed a positive related to postoperative infection; The timing of surgery and postoperative infection are negatively correlated. However, pearson correlation analysis was not show statistically significant between these two factors. Draw the ROC curveof the timing of surgery, the area under the curve is 0.939 (P= 0.001), cutoff value of 6.5, the sensitivity of this cutoff value of 100%, a specificity of 76.5%, the false positive rate was 23.5%, the false negative rate 0%, positive predictive value of 42.9% and a negative predictive value of 100%, Youdon index was 76.5%; CRP draw ROC curve, the area under the curve of 0.907 (P= 0.002). cutoff value of 54.85, the sensitivity of this cutoff value of 83.3%, specificity was 94.1%, the false positive rate was 5.9%, the false negative rate was 16.7%, a positive predictive value of 71.4% and a negative predictive value of 97.0%, Youdon index was 77.4%; draw the timing of surgery and joint experiments CRP ROC curve and found a sensitivity of 83.3% and specificity of 100%, the false positive rate was 5.9%, the false negative rate was 16.7%, a positive predictive value of 100% and a negative predictive value of 97.1%, Youdon index was 83.3%. Considered separately or serum C-reactive protein in predicting the timing of surgery after infection higher sensitivity but lower specificity, the two combined in series after the experiment showed that the specificity and accuracy were improved.ConclusionThis study shows that preoperate factors such as CRP and timing of surgery is high sensitivity predictors to postoperative infection.patients undergoing open fractures before C-reactive protein and the timing of surgery for postoperative infection significantly predictive value, and is not affected by gender, age and other factors,. both at the same time will be included grasp surgical indications (C-reaction Protein<54.85mg/L, surgical time> 6.5 days), will significantly reduce the incidence of postoperative infection rates. However, due to the small sample size, a lot still needs to be further explored in this kind of study. |
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