Dr. Tom Colletti, DHSc, MPAS, PA-C, DFAAP
SURGICAL TIMELINES IN OPEN FRACTURES: IS THE
SIX-HOUR RULE STILL RELEVANT?
by Craig Mosier, MPAS, PA-C
Long-established orthopedic surgery dogma has held that open fractures should be surgically managed within six hours of injury. This was believed to reduce the potential for post-injury infections, and secondarily to decrease the potential for either delayed bony healing or non-union. Recently, evidence-based research has looked closely at whether there was significant data to support the old axiom of the “six-hour window” for the management of open fractures. Multiple studies since the early 1990s have demonstrated that other factors associated with open fractures may be a better determinate of potential post-injury infection rather than the 6-hour rule. The Gustilo-Anderson (GA), classification of the injury, which was established in 1969, is currently believed to be a better predictor of post-injury infection rather than delays in surgical treatment. There was no evidence of significantly increased infection rates based solely on the old six hours to surgery window. Most authors agreed that high GA score injuries required surgical intervention as soon as practicable, and ideally within 12-24 hours.
Mosier CP. Surgical Timelines In Open Fractures: Is The Six-Hour Rule Still Relevant?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2022; 4(4).
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