{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:45:30Z","timestamp":1787161530582,"version":"build-2736575974"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,18]],"date-time":"2020-07-18T00:00:00Z","timestamp":1595030400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,18]],"date-time":"2020-07-18T00:00:00Z","timestamp":1595030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Open fractures are among the most severe injuries observed in orthopedic patients. Treating open fractures is difficult because such patients with infections may require multiple operations and amputations. Furthermore, only a few studies have focused on antibiotic prophylaxis in open fractures and evaluated how to cover lost soft tissue to increase the success rate of reconstruction. We evaluated the risk factors for deep infection in lower limb Gustilo\u2013Anderson (G\u2013A) type\u00a0III fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective study investigated patients who underwent surgical procedures for lower limb G\u2013A type\u00a0III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G\u2013A type\u00a0III fractures (77 G\u2013A type\u00a0IIIA fractures and 37 G\u2013A type\u00a0IIIB fractures) who were followed up for at least 2\u00a0years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G\u2013A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01), G\u2013A classification (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01), duration of antibiotic prophylaxis (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01), timing of wound closure (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01), and incidence of soft-tissue reconstruction failure (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early flaps rather than skin grafting should be used to cover G\u2013A type\u00a0IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level\u00a0IV retrospective observational study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s10195-020-00549-5","type":"journal-article","created":{"date-parts":[[2020,7,18]],"date-time":"2020-07-18T07:02:51Z","timestamp":1595055771000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Retrospective analysis of risk factors for deep infection in lower limb Gustilo\u2013Anderson type III fractures"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9839-7330","authenticated-orcid":false,"given":"Taku","family":"Ukai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Hamahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyasu","family":"Uchiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiko","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,18]]},"reference":[{"key":"549_CR1","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1097\/BOT.0000000000000488","volume":"30","author":"J Westgeest","year":"2015","unstructured":"Westgeest J, Weber D, Dulai SK, Bergman JW, Buckley R, Beaupre LA (2015) Factors associated with development of nonunion or delayed healing after an open long bone fracture: a prospective cohort study of 736 subjects. 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The authors state that this study conforms to the ethical standards laid down in the most recent version of the\u00a0Declaration of Helsinki. All patients were informed about the study and consented to participate.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All patients gave consent for publication.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"10"}}