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Background <p>Gustilo-Anderson type III B/C open tibial fractures are among the most complex and high-risk injuries in trauma care. Their management demands a multidisciplinary approach, and early intervention is critical. While early debridement has been established as essential, the optimal timing for definitive orthoplastic coverage remains less clearly defined.</p> Objective <p>To evaluate whether early orthoplastic coverage reduces the risk of fracture-related infections (FRIs) and complication rates compared to late coverage in type III B/C open tibial fractures.</p> Methods <p>We conducted a PRISMA-compliant systematic review and meta-analysis of studies comparing early versus late orthoplastic treatment in patients with Gustilo-Anderson III B/C open tibial fractures. Databases included PubMed and EMBASE. Primary outcome was FRI; secondary outcomes included amputation, non-union, and revision surgery rates. Risk of bias was assessed using the Newcastle-Ottawa Scale.</p> Results <p>Of 3746 studies screened, five studies with a total of 454 patients met the inclusion criteria. Cutoff for early vs. late treatment was defined variably across studies (either within 72–168&#xa0;h). Meta-analysis showed that early treatment significantly reduced the odds of infection (OR: 0.34; 95% CI: 0.23–0.52; <i>p</i> &lt; 0.001) compared to late treatment. Subgroup analyses confirmed consistent benefits regardless of timing cutoffs or surgical approach (“fix and flap” vs. staged). While trends suggested reduced rates of amputation and non-union with early treatment, these did not reach statistical significance.</p> Conclusion <p>Early orthoplastic coverage significantly reduces FRI in patients with Gustilo-Anderson III B/C open tibial fractures. While secondary outcomes showed positive trends, further high-quality prospective studies are needed.</p>

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Early orthoplastic coverage reduces fracture-related infections in Gustilo III B/C tibial fractures – a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Neil Ruprecht,
  • Felix Karl-Ludwig Klingebiel,
  • Christian Thomas Hübner,
  • Jakob Hax,
  • Henrik Teuber,
  • Kai Oliver Jensen,
  • Christian Hierholzer,
  • Roman Pfeifer,
  • Hans-Christoph Pape,
  • Valentin Neuhaus,
  • Yannik Kalbas

摘要

Background

Gustilo-Anderson type III B/C open tibial fractures are among the most complex and high-risk injuries in trauma care. Their management demands a multidisciplinary approach, and early intervention is critical. While early debridement has been established as essential, the optimal timing for definitive orthoplastic coverage remains less clearly defined.

Objective

To evaluate whether early orthoplastic coverage reduces the risk of fracture-related infections (FRIs) and complication rates compared to late coverage in type III B/C open tibial fractures.

Methods

We conducted a PRISMA-compliant systematic review and meta-analysis of studies comparing early versus late orthoplastic treatment in patients with Gustilo-Anderson III B/C open tibial fractures. Databases included PubMed and EMBASE. Primary outcome was FRI; secondary outcomes included amputation, non-union, and revision surgery rates. Risk of bias was assessed using the Newcastle-Ottawa Scale.

Results

Of 3746 studies screened, five studies with a total of 454 patients met the inclusion criteria. Cutoff for early vs. late treatment was defined variably across studies (either within 72–168 h). Meta-analysis showed that early treatment significantly reduced the odds of infection (OR: 0.34; 95% CI: 0.23–0.52; p < 0.001) compared to late treatment. Subgroup analyses confirmed consistent benefits regardless of timing cutoffs or surgical approach (“fix and flap” vs. staged). While trends suggested reduced rates of amputation and non-union with early treatment, these did not reach statistical significance.

Conclusion

Early orthoplastic coverage significantly reduces FRI in patients with Gustilo-Anderson III B/C open tibial fractures. While secondary outcomes showed positive trends, further high-quality prospective studies are needed.