Open tibia fractures are devastating, life changing injuries, with infection associated with substantial morbidity to the patient. Reducing infection is a research priority, but before interventional studies can be designed, the incidence of infection following this injury needs to be better defined. Our aim was to estimate the global incidence of infection following an open tibia fracture. A systematic review was performed of MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), Web of Science and Global Index Medicus. We included randomised controlled trials with more than ten participants which reported infections after open diaphyseal or distal fractures (AO 42 or 43). Primary outcome was deep infection according to the Centres for Disease Control and Prevention criteria. Secondary outcome included causative micro-organisms. A meta-analysis using a random effects model to assess incidence and between-treatment effects was performed. Thirteen studies including 1463 adults from seven middle-income countries, seven high-income countries and one low-income country were included. The incidence of infection was 12.12 person-years (95% CI 7.95–18.47). A subgroup analysis compared external fixation and intramedullary nailing showed no difference between infection rates. There were limited data on organisms, but Staphylococcus aureus was the most commonly identified. There are limited to no data on antimicrobial resistance.

中文翻译：

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高、中、低收入国家开放性胫骨骨折后感染发生率及引起感染的微生物的荟萃分析

开放性胫骨骨折是毁灭性的、改变生活的伤害，感染与患者的严重发病率相关。减少感染是研究的重点，但在设计介入研究之前，需要更好地确定这种损伤后的感染发生率。我们的目的是估计开放性胫骨骨折后的全球感染发生率。对 MEDLINE、EMBASE、对照试验中央注册库 (CENTRAL)、Web of Science 和 Global Index Medicus 进行了系统评价。我们纳入了十多名参与者的随机对照试验，这些试验报告了开放性骨干或远端骨折后的感染（AO 42 或 43）。根据疾病控制和预防中心的标准，主要结果是深度感染。次要结果包括致病微生物。使用随机效应模型进行荟萃分析来评估发病率和治疗间效应。纳入了 13 项研究，涉及来自 7 个中等收入国家、7 个高收入国家和 1 个低收入国家的 1463 名成年人。感染发生率为 12.12 人年（95% CI 7.95–18.47）。比较外固定和髓内钉的亚组分析显示感染率没有差异。关于生物体的数据有限，但金黄色葡萄球菌是最常见的。关于抗菌素耐药性的数据有限，甚至没有。