• OBJECTIVES
    • To measure time to flap coverage after open tibia fractures and assess whether delays are associated with inpatient complications.
  • DESIGN
    • Retrospective cohort study.
  • SETTING
    • One forty level I and II trauma centers in Canada and the United States.
  • PATIENTS/PARTICIPANTS
    • Adult patients (≥16 years) undergoing surgery for (1) an open tibia (including ankle) fracture and (2) a soft-tissue flap during their index admission between January 1, 2012, and December 31, 2015, were eligible for inclusion.
  • EXPOSURE
    • Time from hospital arrival to definitive flap coverage (in days).
  • MAIN OUTCOME MEASUREMENTS
    • The primary outcome was a composite of the following complications occurring during the index admission: (1) deep infection, (2) osteomyelitis, and/or (3) amputation. The primary analysis compared complications between early and delayed coverage groups (≤7 and >7 days, respectively) after matching on propensity scores. We also used logistic regression with time to flap coverage as a continuous variable to examine the impact of the duration of delay on complications.
  • RESULTS
    • There were 672 patients at 140 centers included. Of these, 412 (61.3%) had delayed coverage (>7 days). Delayed coverage was associated with a significant increase in complications during the index admission after matching (16.7% vs. 6.2%, P < 0.001, number needed to harm = 10). Each additional week of delay was associated with an approximate 40% increased adjusted risk of complications (adjusted odds ratio 1.44, 95% confidence interval 1.13-1.82, for each week coverage was delayed, P = 0.003).
  • CONCLUSION
    • This is the first multicenter study of flap coverage for tibia fractures in North America. Complications rose significantly when flap coverage was delayed beyond 7 days, consistent with current guideline recommendations. Because the majority of patients did not have coverage within this timeframe, initiatives are required to improve care for patients with these injuries.
  • LEVEL OF EVIDENCE
    • Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.