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25.07.2017 | Review Article | Ausgabe 10/2017

International Orthopaedics 10/2017

Risk factors for infectious complications after open fractures; a systematic review and meta-analysis

International Orthopaedics > Ausgabe 10/2017
Kirsten Kortram, Hans Bezstarosti, Willem-Jan Metsemakers, Michael J. Raschke, Esther M.M. Van Lieshout, Michael H.J. Verhofstad
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Electronic supplementary material

The online version of this article (doi:10.​1007/​s00264-017-3556-5) contains supplementary material, which is available to authorized users.



The purpose of this study was to identify risk factors for the development of infection after open fracture fixation.


A comprehensive search in all scientific literature of the last 30 years was performed in order to identify patient-, trauma-, diagnosis- and treatment-related risk factors. Studies were included when infectious complications were assessed in light of one or more risk factors. A meta-analysis was performed. Risk ratios (RR) or risk differences (RD) with 95% confidence intervals were calculated.


A total of 116 manuscripts were included. Male gender (RR 1.42), diabetes mellitus (DM) (RR 1.72), smoking (RR1.29), a lower extremity fracture (RR 1.94), Gustilo-Anderson grade III open fracture (RR 3.01), contaminated fracture (RR 7.85) and polytrauma patients (RR 1.49) were identified as statistically significant risk factors for the development of infectious complications. Of the treatment-related risk factors, only pulsatile lavage was associated with a higher infectious complication rate (RR 2.70).


A number of risk factors for the development of infections after open fractures have been identified in the available literature. These factors should still be tested for independence in a multivariable model. Prospective, observational studies are needed to identify and quantify individual risk factors for infection after open fracture fixation.

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