Introduction: Open tibia fractures can be debilitating injuries with relatively high rates of complications. Since the development of Gustilo and Anderson’s open fracture classification 40 years ago, much attention has been focused on methods to decrease infection associated with open
tibia fractures. The purpose of this study was to review the past four decades of open tibia infection rates to determine if modern surgical and medical innovations have improved outcomes.

Methods: A systematic review of the literature was performed to identify published articles that reported infection rates for open tibia fractures. The initial query resulted in 647 articles. After implementing exclusion criteria, 165 articles were included in the final analysis. Studies were
grouped into 1 of 4 decades based on the year(s) in which the study took place: 1977-1987,1988-1998, 1999-2009, or 2010-2017. Demographic data, open fracture classifications, and infection rates were collected from each article. Comparisons were then made between studies in each of the 4 decades.

Results: A total of 11,297 patients were included from the 165 studies with 743 patients in the first decade, 3,644 in the second decade, 4,678 in the third decade, and 2,232 in the most recent decade. There was an overall infection rate of 12.1% over the 40-year period with 1,910 Gustilo Anderson type I open tibia fractures, 2,837 type II fractures, 2,854 type IIIA fractures, 3,224 type IIIB fractures, and 472 type IIIC fractures. Overall, the rate of infection following open tibia fractures did not differ between 1977-1987 (9.45%), 1988-1998 (13.12%), 1999-2009 (14.6%), or 2010-2018 (11.2%).

Conclusions: Our data on 11,000 open tibia fractures from 1977-2017 suggests that the rate of infection following open tibia fractures has not changed. Further investigations into methods to reduce infection rates in patients with open tibia fractures are warranted.

Have Infection Rates Following Open Tibia Fractures Changed? A Review of 11,000 Open Tibia Fractures Over 4 Decades