Debridement and wound closure of open fractures: The impact of the time factor on infection rates

SummaryOpen fracture management represents an orthopaedic emergency. Early aggressive management of these debilitating injuries within the first 6 h has been encouraged in order to minimise the risk of infection and long term sequelae. Debridement and wash-out of the wound, followed by stabilisation of the bony elements and closure of the soft-tissue envelope are all considered essential. However, the available scientific evidence supporting the timing of this multistage approach of open fracture management, and the “Six-hour rule” itself, are unclear. This review article analyses the available evidence regarding the impact of the timing of wound debridement and closure of open fractures of the lower extremity.