Early debridement and definitive fixation, at the initial operative setting, historically led
to no difference in the infection rates for Gustilo-Anderson type III open tibia fractures.
However, Lenarz et al. reported that delaying definitive fixation in open tibia fractures
could decrease the deep infection rate. At the University of Missouri, the investigators
found that staged procedures, including initial debridement-temporary fixation and delayed
definitive fixation, did not statistically decrease the rate of deep infection in
Gustilo-Anderson type III fractures, prompting the study that is being proposed here.
Antibiotic cement coated intramedullary nails have been used in management of infected long
bone fractures. Since external fixation and staged debridement did not decrease type III open
tibia infection rate, the investigators wanted to consider using antibiotic cement coated
nails to deliver antibiotics locally in the acute open fracture setting to prophylactically
decrease associated infection rate. Additionally, Irrisept is a wound irrigant that has been
used to lower infection rates in different wound settings. To the investigators' knowledge,
there are no robust data showing its effectiveness at lowering infection rates in open tibia
fracture management. The purpose of this study is to determine the effects of Irrisept and
antibiotic nails on lowering deep infection rates in type III open tibia fractures.