{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:52:03Z","timestamp":1787820723381,"version":"build-2784847793"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>Determine the proportion of subjects developing deep infection or nonunion after primary wound closure of open fractures (humerus, radius\/ulna, femur, and tibia\/fibula). Secondarily, a matched-series analysis compared outcomes with subjects who underwent delayed wound closure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Prospective cohort between 2009 and 2013 of subjects undergoing primary closure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Participants:<\/jats:title>\n            <jats:p>Eighty-three (84 fractures) subjects were enrolled. Eighty-two (99%) subjects (83 fractures) provided follow-up data. Matching (age, sec, fracture location, and grade) was performed using study data of delayed wound closure undertaken at the same center between 2001 and 2009 (n = 68 matched subjects).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>Primary wound closure occurred when the fracture grade was Gustilo grade 3A or lower and the wound deemed clean at initial surgery. Standardized evaluations occurred until the fracture(s) healed; phone interviews and chart reviews were also undertaken at 1 year.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measurements:<\/jats:title>\n            <jats:p>Deep infection is defined as infection requiring unplanned surgical debridement and\/or sustained antibiotic therapy after wound closure; nonunion is defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing 1-year after fracture.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Three (4%) subjects had deep infections, whereas 10 (12%) subjects developed nonunion in the primary closure cohort. In the matched analyses [n = 68 pairs; (136 subjects)], the primary closure cohort had fewer deep infections [n = 3 (4%) vs. n = 6 (9%)] and nonunions [n = 9 (13%) vs. n = 19 (29%)] than the delayed closure cohort (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Primary wound closure after an open fracture appears acceptable in appropriately selected patients and may reduce the risk of deep infection and nonunion compared with delayed closure; a definitive randomized trial is needed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000000751","type":"journal-article","created":{"date-parts":[[2016,12,14]],"date-time":"2016-12-14T12:08:51Z","timestamp":1481717331000},"page":"121-126","source":"Crossref","is-referenced-by-count":44,"title":["Primary Wound Closure After Open Fracture: A Prospective Cohort Study Examining Nonunion and Deep Infection"],"prefix":"10.1097","volume":"31","author":[{"given":"Angela V.","family":"Scharfenberger","sequence":"first","affiliation":[{"name":"Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Alabassi","sequence":"additional","affiliation":[{"name":"Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Smith","sequence":"additional","affiliation":[{"name":"Infectious Diseases; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Weber","sequence":"additional","affiliation":[{"name":"Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukhdeep K.","family":"Dulai","sequence":"additional","affiliation":[{"name":"Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph W.","family":"Bergman","sequence":"additional","affiliation":[{"name":"Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A.","family":"Beaupre","sequence":"additional","affiliation":[{"name":"Surgery;"},{"name":"Physical Therapy, University of Alberta, Edmonton, AB, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230828","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2106\/JBJS.K.00582","article-title":"Does timing to operative debridement affect infectious complications in open long-bone fractures? 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