This systematic review and meta-analysis of 16 cohort studies (3,539 open long-bone fractures) asks whether the timing of operative debridement relative to injury — specifically the widely taught six-hour rule — actually affects infectious complication rates.
When an open tibia fracture arrives at 2 AM and OR resources are suboptimal, this study supports a thoughtful decision to delay to daylight hours — provided antibiotics are given immediately and the delay is not elective.
Debridement quality and early antibiotic administration matter more than whether you beat the six-hour clock.
This systematic review and meta-analysis of 16 cohort studies (3,539 open long-bone fractures) asks whether the timing of operative debridement relative to injury — specifically the widely taught six-hour rule — actually affects infectious complication rates.
When an open tibia fracture arrives at 2 AM and OR resources are suboptimal, this study supports a thoughtful decision to delay to daylight hours — provided antibiotics are given immediately and the delay is not elective.
Debridement quality and early antibiotic administration matter more than whether you beat the six-hour clock.