Risk factors for infection following open fracture:
(1) primary closure of wounds under tension (increases the risk for a compartment syndrome)
(2) failure to recognize a compartment syndrome
(3) incomplete excision of poorly vascularized tissue
(4) inadequate hemostasis
(5) insufficient wound drainage
(6) rough soft tissue handling during surgery
(7) wrong implant (such as large metallic fixation device implanted into poorly vascularized tissue)
(8) poorly vascularized soft tissue cover
Gustilo et al also included:
(9) fracture instability
Additional items might be:
(10) excessive or inadequate removal of environmental materials (contamination).
(11) failure to administer adequate antibiotic prophylaxis.
Repeated debridement of poorly vascularized tissue is not associated with increased risk of infection.
