The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: a 9-year prospective study from a district general hospital

Injury. 2007 Aug;38(8):900-5. doi: 10.1016/j.injury.2007.02.043. Epub 2007 Jun 20.


Aims: To determine whether a delay of greater than 6h from injury to initial surgical debridement and the timing of antibiotic administration affect infection rates in open long-bone fractures.

Methods: We studied 248 consecutive open long-bone fractures in 237 patients over a 9-year period. The patients were followed until clinical or radiological union occurred or until a secondary procedure for non-union or infection was performed.

Results: Surgical debridement was performed within 6h of injury in 62% of cases and after 6h in 38% of cases. Infection rates were 7.8% and 9.6%, respectively, and the difference was not statistically significant (p=0.6438). The timing of antibiotic administration was not significantly related to the infection rate.

Conclusion: Whilst open long-bone fractures should be treated expeditiously, we suggest that adherence to a 6h window has not been shown to affect infection rates nor has the timing of antibiotic administration during the acute phase.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Arm Bones / injuries
  • Arm Bones / surgery
  • Cefuroxime / therapeutic use
  • Debridement*
  • Fracture Healing
  • Fractures, Open / surgery*
  • Humans
  • Leg Bones / injuries
  • Leg Bones / surgery
  • Metronidazole / therapeutic use
  • Prospective Studies
  • Time Factors
  • United Kingdom / epidemiology
  • Wound Infection / epidemiology*
  • Wound Infection / prevention & control


  • Anti-Bacterial Agents
  • Metronidazole
  • Cefuroxime