Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting
Background: Machete cut fracture is a unique subset of open fracture. The sharp force of a wielded machete that cleanly divides soft tissue envelope with minimal or no contusion results in an open fracture wound that is relatively less prone to infection. However, in resource-limited settings, the w...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-09-01
|
| Series: | African Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X22000295 |
| _version_ | 1811334294028681216 |
|---|---|
| author | Njoku Isaac Omoke Christian Chukwuemeka Madubueze Francis Ndubuisi Ahaotu Chinedu Gregory Nwigwe Anthony Anakweze Anagor Peace Ifeoma Amaraegbulam Agama Nnachi Egwu Omolade Ayoola Lasebikan |
| author_facet | Njoku Isaac Omoke Christian Chukwuemeka Madubueze Francis Ndubuisi Ahaotu Chinedu Gregory Nwigwe Anthony Anakweze Anagor Peace Ifeoma Amaraegbulam Agama Nnachi Egwu Omolade Ayoola Lasebikan |
| author_sort | Njoku Isaac Omoke |
| collection | DOAJ |
| description | Background: Machete cut fracture is a unique subset of open fracture. The sharp force of a wielded machete that cleanly divides soft tissue envelope with minimal or no contusion results in an open fracture wound that is relatively less prone to infection. However, in resource-limited settings, the wound infection rate after machete cut fracture is relatively high. This study aimed to determine the risk factors for wound infection after extremity machete cut fractures in a Nigerian setting. Methods: We undertook a retrospective analysis of the patients who were seen in the Emergency room of two tertiary hospitals in Nigeria with a machete cut extremity fracture from 2009 to 2018. The association of wound infection with population and wound characteristics as well as intervention related factors were evaluated. Statistical significant factors for wound infection in the Univariable analysis were entered into a Multivariable regression analysis to evaluate the risk of each factor when adjusted to other factors. Results: There were 113 machete-cut fractured bones in 67 eligible patients and wound infection was a complication in 45 (39.8%) of the cases (95%CI 30.3 – 49.7%).The factors significantly associated with high wound infection rate were smoking, haematocrit < 30%, fractures sustained outdoors, lower extremity fractures, a wound size of >5cm in length, injury-to-hospital arrival interval > 6hrs. Multivariable regression analysis identified wound size >5 cm (aOR 14.142, 95%CI (2.716 - 73.636); p = 0.002), injury-to- hospital arrival interval later than 6hrs (aOR 4.410, 95% CI (1.003-19.394); p = 0.050) and administration of antibiotics later than 3hrs of injury (aOR 5.736, 95%CI (aOR1.362 - 24.151; p = 0.017) as independent risk factors for wound infection. Conclusion: Wound infection after open fractures caused by machetecut is more likely to occur in patients that present later than six hours after injury, wounds more than 5cm in length and delayed antibiotic administration. Appropriate treatment protocols can be instituted with this knowledge. |
| first_indexed | 2024-04-13T17:05:41Z |
| format | Article |
| id | doaj.art-f88983f753444443be0b459da8fe5cc7 |
| institution | Directory Open Access Journal |
| issn | 2211-419X |
| language | English |
| last_indexed | 2024-04-13T17:05:41Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj.art-f88983f753444443be0b459da8fe5cc72022-12-22T02:38:29ZengElsevierAfrican Journal of Emergency Medicine2211-419X2022-09-01123270275Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited settingNjoku Isaac Omoke0Christian Chukwuemeka Madubueze1Francis Ndubuisi Ahaotu2Chinedu Gregory Nwigwe3Anthony Anakweze Anagor4Peace Ifeoma Amaraegbulam5Agama Nnachi Egwu6Omolade Ayoola Lasebikan7Department of Surgery, Ebonyi State University, Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State; Corresponding AuthorDepartment of Surgery, National Hospital Abuja NigeriaDepartment of Orthopaedic Surgery, National Orthopaedic Hospital Enugu NigeriaDepartment of Surgery, Ebonyi State University, Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi StateDepartment of Surgery Alex Ekwueme Federal University Teaching Hospital Abakaliki NigeriaDepartment of Surgery Federal Medical Centre Umuahia NigeriaDepartment of Surgery Alex Ekwueme Federal University Teaching Hospital Abakaliki NigeriaDepartment of Orthopaedic Surgery, National Orthopaedic Hospital Enugu NigeriaBackground: Machete cut fracture is a unique subset of open fracture. The sharp force of a wielded machete that cleanly divides soft tissue envelope with minimal or no contusion results in an open fracture wound that is relatively less prone to infection. However, in resource-limited settings, the wound infection rate after machete cut fracture is relatively high. This study aimed to determine the risk factors for wound infection after extremity machete cut fractures in a Nigerian setting. Methods: We undertook a retrospective analysis of the patients who were seen in the Emergency room of two tertiary hospitals in Nigeria with a machete cut extremity fracture from 2009 to 2018. The association of wound infection with population and wound characteristics as well as intervention related factors were evaluated. Statistical significant factors for wound infection in the Univariable analysis were entered into a Multivariable regression analysis to evaluate the risk of each factor when adjusted to other factors. Results: There were 113 machete-cut fractured bones in 67 eligible patients and wound infection was a complication in 45 (39.8%) of the cases (95%CI 30.3 – 49.7%).The factors significantly associated with high wound infection rate were smoking, haematocrit < 30%, fractures sustained outdoors, lower extremity fractures, a wound size of >5cm in length, injury-to-hospital arrival interval > 6hrs. Multivariable regression analysis identified wound size >5 cm (aOR 14.142, 95%CI (2.716 - 73.636); p = 0.002), injury-to- hospital arrival interval later than 6hrs (aOR 4.410, 95% CI (1.003-19.394); p = 0.050) and administration of antibiotics later than 3hrs of injury (aOR 5.736, 95%CI (aOR1.362 - 24.151; p = 0.017) as independent risk factors for wound infection. Conclusion: Wound infection after open fractures caused by machetecut is more likely to occur in patients that present later than six hours after injury, wounds more than 5cm in length and delayed antibiotic administration. Appropriate treatment protocols can be instituted with this knowledge.http://www.sciencedirect.com/science/article/pii/S2211419X22000295Machete cutopen fracturewound infectionrisk factor |
| spellingShingle | Njoku Isaac Omoke Christian Chukwuemeka Madubueze Francis Ndubuisi Ahaotu Chinedu Gregory Nwigwe Anthony Anakweze Anagor Peace Ifeoma Amaraegbulam Agama Nnachi Egwu Omolade Ayoola Lasebikan Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting African Journal of Emergency Medicine Machete cut open fracture wound infection risk factor |
| title | Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting |
| title_full | Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting |
| title_fullStr | Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting |
| title_full_unstemmed | Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting |
| title_short | Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting |
| title_sort | analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource limited setting |
| topic | Machete cut open fracture wound infection risk factor |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X22000295 |
| work_keys_str_mv | AT njokuisaacomoke analysisofriskfactorsforwoundinfectionafterextremityfracturecausedbymachetecutinaresourcelimitedsetting AT christianchukwuemekamadubueze analysisofriskfactorsforwoundinfectionafterextremityfracturecausedbymachetecutinaresourcelimitedsetting AT francisndubuisiahaotu analysisofriskfactorsforwoundinfectionafterextremityfracturecausedbymachetecutinaresourcelimitedsetting AT chinedugregorynwigwe analysisofriskfactorsforwoundinfectionafterextremityfracturecausedbymachetecutinaresourcelimitedsetting AT anthonyanakwezeanagor analysisofriskfactorsforwoundinfectionafterextremityfracturecausedbymachetecutinaresourcelimitedsetting AT peaceifeomaamaraegbulam analysisofriskfactorsforwoundinfectionafterextremityfracturecausedbymachetecutinaresourcelimitedsetting AT agamannachiegwu analysisofriskfactorsforwoundinfectionafterextremityfracturecausedbymachetecutinaresourcelimitedsetting AT omoladeayoolalasebikan analysisofriskfactorsforwoundinfectionafterextremityfracturecausedbymachetecutinaresourcelimitedsetting |