{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:50:01Z","timestamp":1777881001109,"version":"3.51.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Orthop Surg (Hong Kong)"],"published-print":{"date-parts":[[2020,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To prospectively evaluate whether time to debridement has any correlation with union, infection, and quality of life in high-grade lower limb fractures in a tropical setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A prospective cohort study was conducted at a tertiary care center in South India. Two hundred fifty-four adult skeletally mature patients with 301 grade 3 fractures involving the femur, tibia, or fibula were recruited. The cohort was empirically divided into two groups (early and late) based on the time to debridement (less than or more than 12 h from injury).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome:<\/jats:title>\n                    <jats:p>The primary outcome was nonunion. Secondary outcomes were deep infection rates and patients\u2019 quality of life. Short form-36 (SF-36) and short musculoskeletal functional assessment (SMFA) questionnaires were also used. Patients were followed up for 9 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The follow-up rate was 93%. The late group had a significantly higher risk of nonunion (odds ratio(OR): 6.5, 95% confidence interval (CI): 2.82\u201314.95) and infections (OR: 6.05, 95% CI: 2.85\u201312.82). There was a 4% increase in the infection risk for each hour of delay for the initial 50 h ( p &lt; 0.0001). SF-36 and SMFA scores were superior in the early group ( p &lt; 0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The study contradicts findings reported in the literature from the West. Our study was in agreement with our hypothesis and proved that debridement within 12 h resulted in significantly lower rates of nonunion and infections and an overall improved quality of life in high-grade open lower limb fractures in a developing country.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>Level II<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>German Clinical Trials Register DRKS00015186<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2309499020907558","type":"journal-article","created":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T09:35:11Z","timestamp":1584524111000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Time to debridement in open high-grade lower limb fractures and its effect on union and infections: A prospective study in a tropical setting"],"prefix":"10.1177","volume":"28","author":[{"given":"Christina Marie","family":"Joseph","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1842-5907","authenticated-orcid":false,"given":"Thilak Samuel","family":"Jepegnanam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boopalan","family":"Ramasamy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinoo Mathew","family":"Cherian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manasseh","family":"Nithyananth","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thambu David","family":"Sudarsanam","sequence":"additional","affiliation":[{"name":"Department of Medicine Unit 2, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prasanna Samuel","family":"Premkumar","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Wellcome Trust Research Laboratory, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,3,18]]},"reference":[{"key":"bibr1-2309499020907558","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00984"},{"key":"bibr2-2309499020907558","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00582"},{"key":"bibr3-2309499020907558","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.96B3.32380"},{"key":"bibr4-2309499020907558","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000197"},{"key":"bibr5-2309499020907558","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000488"},{"key":"bibr6-2309499020907558","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(98)00125-9"},{"key":"bibr7-2309499020907558","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2011.12.007"},{"key":"bibr8-2309499020907558","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5413.43373"},{"key":"bibr9-2309499020907558","doi-asserted-by":"crossref","unstructured":"WHO. 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