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Orthopaedic Surgery Apr 2020To analyze the relationship between the length from injury to first debridement (LFITFD) of open tibial fractures and perioperative infection, and explore independent...
OBJECTIVE
To analyze the relationship between the length from injury to first debridement (LFITFD) of open tibial fractures and perioperative infection, and explore independent risk factors related to infection.
METHODS
This retrospective study focused on 215 clinical patients with open tibial fractures who were admitted from January 2012 to January 2017. According to the time from injury to the operation, the patients were categorized into four groups: LFITFD ≤ 6 h, 6 < LFITFD ≤ 12 h, 12 < LFITFD≤24 h, and (LFITFD > 24 h). Infection risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors.
RESULTS
The infection rates of four groups were 9.2%, 9.5%, 11.1%, and 10.5% with six of 65, nine of 95, four of 36, and two of 19 patients being infected, respectively. There was no statistical significance between the four groups. The infection rates among fractures of different Gustilo-Anderson classifications were as follows. Of 62 cases of type I fractures, two were infected, and the infection rate was 3.2%. Among those with type II fractures, eight were infected, and the infection rate was 8.2%. Three of 26 cases of type IIIA fracture were infected, yielding an infection rate of 11.5%, seven of 25 cases of type III B fracture were infected (28% infection rate), and one of four cases of type III C fracture was infected (25% infection rate). There was a statistically significant difference between the five groups. Multivariate regression analysis showed that smoking, combined diabetes, surgical time, and fracture Gustilo-Anderson classification were independent risk factors for perioperative infection of open tibial fractures, and the difference in time from injury to first debridement was not related to infection.
CONCLUSION
The incidence of perioperative infection in patients with open tibial fractures has little to do with the time of the first debridement, which is mainly related to the level of the fracture's Gustilo-Anderson classification. At the same time, smoking is prohibited before the operation, the patient's blood glucose is managed, and the debridement operation time is minimized conducive to reducing the incidence of infection.
Topics: Adult; Debridement; Female; Fracture Fixation; Fractures, Open; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Surgical Wound Infection; Tibial Fractures; Time-to-Treatment
PubMed: 32202051
DOI: 10.1111/os.12653 -
Chinese Journal of Traumatology =... Dec 2019Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1% of all fractures. Open fracture takes 5%-10% of the all distal...
PURPOSE
Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1% of all fractures. Open fracture takes 5%-10% of the all distal femoral fractures, which is at an increased risk of complications. There were limited studies which documented the outcomes of such cases. The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.
METHODS
This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India. Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. They were followed for minimum of six months. Patients were followed up monthly for first four months, at six months and one year after surgery. Clinical and radiological signs of healing, any complications, time to union, and functional outcome were assessed.
RESULTS
The mean age of patients was 44.33 years (range 20-82 years) with male predominance of 66.7%. According to Gustilo-Anderson classification, there were 5, 15 and 10 patients with open grade I, II and IIIA distal femoral fractures respectively. According to orthopaedic trauma association (OTA) classification, majority of patients in our study were of C3 type. The mean time to bony union was 5.6 months (range 4-9 months). Average postoperative knee range of motion (ROM) at the latest follow-up was 98⁰ (range 70⁰-120⁰). Lysholm knee scoring scale showed excellent score in 11 patients, good in 9 patients, fair and poor in 5 patients each; however, there was no significant correlation with fracture pattern types (p < 0.05). Knee stiffness was the major complications encountered in the study. The knee ROM was <90⁰ in 5 patients and 90⁰-120⁰ in rest of the patients, while 1 patient had extensor lag of 10⁰. One patient had implant failure and lost to follow-up; 3 patients had deep infection.
CONCLUSION
An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Collagen; Debridement; Female; Femoral Fractures; Fracture Fixation, Internal; Fractures, Open; Humans; Male; Middle Aged; Prospective Studies; Treatment Outcome; Young Adult
PubMed: 31753759
DOI: 10.1016/j.cjtee.2019.08.005 -
Journal of Orthopaedic Surgery and... Apr 2021Implant-associated infections depict a major challenge in orthopedics and trauma surgery putting a high burden on the patients and health care systems, strongly...
Treatment of severely open tibial fractures, non-unions, and fracture-related infections with a gentamicin-coated tibial nail-clinical outcomes including quality of life analysis and psychological ICD-10-based symptom rating.
BACKGROUND
Implant-associated infections depict a major challenge in orthopedics and trauma surgery putting a high burden on the patients and health care systems, strongly requiring improvement of infection prevention and of clinical outcomes. One strategy includes the usage of antimicrobial-coated implants. We evaluated outcomes after surgical treatment using a gentamicin-coated nail on (i) treatment success in terms of bone consolidation, (ii) absence of infection, and (iii) patient-reported quality of life in a patient cohort with high risk of infection/reinfection and treatment failure.
METHODS
Thirteen patients with open tibia fractures (n = 4), non-unions (n = 2), and fracture-related infection (n = 7) treated with a gentamicin-coated intramedullary nail (ETN Protect) were retrospectively reviewed. Quality of life was evaluated with the EQ-5D, SF-36, and with an ICD-10-based symptom rating (ISR).
RESULTS
At a mean follow-up of 2.8 years, 11 of the 13 patients (84.6%) achieved bone consolidation without any additional surgical intervention, whereas two patients required a revision surgery due to infection and removal of the implant. No specific implant-related side effects were noted. Quality of life scores were significantly lower compared to a German age-matched reference population. The mean ISR scores revealed mild psychological symptom burden on the scale depression.
CONCLUSION
The use of a gentamicin-coated intramedullary nail seems to be reasonable in open fractures and revision surgery for aseptic non-union or established fracture-related infection to avoid infection complications and to achieve bony union. Despite successful treatment of challenging cases with the gentamicin-treated implant, significantly reduced quality of life after treatment underlines the need of further efforts to improve surgical treatment strategies and psychological support.
Topics: Adult; Aged; Anti-Bacterial Agents; Bone Nails; Device Removal; Female; Fracture Fixation, Intramedullary; Fractures, Open; Gentamicins; Humans; International Classification of Diseases; Male; Middle Aged; Prosthesis-Related Infections; Quality of Life; Reoperation; Retrospective Studies; Tibial Fractures; Trauma Severity Indices; Treatment Outcome; Wound Infection; Young Adult
PubMed: 33865407
DOI: 10.1186/s13018-021-02411-8 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Nov 2020Open fractures constitute an important mortality and morbidity cause among all musculoskeletal system injuries and bring along many social and economic problems. The...
BACKGROUND
Open fractures constitute an important mortality and morbidity cause among all musculoskeletal system injuries and bring along many social and economic problems. The cost occurring due to both long treatment duration and the delay in returning to work made these conditions more complicated. The present study aims to evaluate of the complications which may occur in cases with an application of internal fixation following external fixator in upper and lower extremity open fractures retrospectively.
METHODS
Forty-nine patients, who applied to the emergency service between 2007 and 2013, participated in this study. Thirty-two of these patients consisted of the patients to whom external fixator was first placed, and then internal fixation was performed by us, while 17 patients were treated in another center with the external fixator, and then their treatments were performed by us. All patients' injury mechanism, duration of follow-up with an external fixator, whether debridement was performed after external fixator, the period between external fixation and internal fixation, pin site infection, duration of the union, delayed union, nonunion, whether bone graft was used during internal fixation, internal fixation type, reoperation, development of osteomyelitis and follow-up parameters were recorded.
RESULTS
Results were evaluated separately for radius, humerus, tibia and femur fractures. Of the 49 patients, 39 were male, and 10 were female. Mean follow-up time for tibia 28.6 months, for femur 34, for humerus 26.9, for Radius 27 months. Of the 49 patients who participated in this study, 15 applied with upper extremity (11 humeri, 4 Radius) injury and 34 applied with lower extremity (25 tibias, 9 femora) injury. Of the 49 patients, 32 had pin tract infection, 11 had nonunion, 11 had delayed union, two had osteomyelitis.
CONCLUSION
Open fractures are always hard to treat. After external fixation to the internal fixation process have some complications, phsycians should be aware of all these problems and plan according to the situation.
Topics: Arm Injuries; Female; Fracture Fixation; Fractures, Open; Humans; Leg Injuries; Male; Orthopedic Fixation Devices; Postoperative Complications; Retrospective Studies
PubMed: 33107969
DOI: 10.14744/tjtes.2020.80236 -
The Cochrane Database of Systematic... 2004Wound and bone infections are frequently associated with open fractures of the extremities and may add significantly to the resulting morbidity. The administration of... (Review)
Review
BACKGROUND
Wound and bone infections are frequently associated with open fractures of the extremities and may add significantly to the resulting morbidity. The administration of antibiotics is routinely used in developed countries as an adjunct to a comprehensive management protocol that also includes irrigation, surgical debridement and stabilisation when indicated, and is thought to reduce the frequency of infections.
OBJECTIVES
To quantify the evidence for the effectiveness of antibiotics in the initial treatment of open fractures of the limbs.
SEARCH STRATEGY
We searched the Cochrane Musculoskeletal Injuries Group specialised register (April 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (1966 to April 2003), EMBASE (1988 to April 2003), LILACS (1992 to June 2002) and reference lists of articles. Proceedings of meetings of the American Academy of Orthopaedic Surgeons (1980 to 2001), the Orthopaedic Trauma Association (1990 to 2001) and the Société Internationale de Chirurgie Orthopedique et Traumatologique (1980 to 2001) were hand searched. We also contacted published researchers in the field.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials involving: participants - people of any age with open fractures of the limbs; intervention - antibiotic administered before or at the time of primary treatment of the open fracture compared with placebo or no antibiotic; outcome measures - early wound infection, chronic drainage, acute or chronic osteomyelitis, delayed unions or non-unions, amputations and deaths.
DATA COLLECTION AND ANALYSIS
Two reviewers independently screened papers for inclusion, assessed trial quality using an eight item scale, and extracted data. Additional information was sought from three trialists. Pooled data are presented graphically.
MAIN RESULTS
Data from 913 participants in seven studies were analysed. The use of antibiotics had a protective effect against early infection compared with no antibiotics or placebo (relative risk 0.41 (95% confidence interval (CI) 0.27 to 0.63); absolute risk reduction 0.08 (95% CI 0.04 to 0.12); NNT 13 (95% CI 8 to 25)). There were insufficient data in the included studies to evaluate other outcomes.
REVIEWER'S CONCLUSIONS
Antibiotics reduce the incidence of early infections in open fractures of the limbs. Further placebo controlled randomised trials are unlikely to be justified in middle and high income countries. Further research is necessary to the determine the avoidable burden of morbidity in countries where antibiotics are not used routinely in the management of open fractures.
Topics: Antibiotic Prophylaxis; Fractures, Open; Humans; Randomized Controlled Trials as Topic; Wound Infection
PubMed: 14974035
DOI: 10.1002/14651858.CD003764.pub2 -
Bosnian Journal of Basic Medical... Nov 2005The large spectrum of open fractures is an amalgamation of injuries with the single variable in common of communication of the fractured bone with the outside... (Review)
Review
The large spectrum of open fractures is an amalgamation of injuries with the single variable in common of communication of the fractured bone with the outside environment, and thus an increased risk for infection. Contributing to the presence of bacteria within the fracture site is devascularized soft tissue, the degree of which can be directly attributed to the amount of energy imparted to the tissues. The currently used classification system aids in defining the degree of severity of these injuries and their subsequent risk for infection. The basic management principal for all of these injury patterns remains essentially the same, however: prevention of infection through debridement, wound management, antibiotic usage, and fracture stabilization. Frequently multiple surgical procedures will be required in order to obtain an infection free, united fracture with adequate soft tissue coverage (1).
Topics: Anti-Bacterial Agents; Bone Nails; Bone Plates; Debridement; Fracture Fixation; Fractures, Open; Humans; Infection Control; Plastic Surgery Procedures; Therapeutic Irrigation; Wounds and Injuries
PubMed: 16351592
DOI: 10.17305/bjbms.2005.3224 -
Hand (New York, N.Y.) Jan 2021The aim of the study is to determine the reliability of the Tulipan-Ilyas (TI) classification among hand surgeons by utilizing several case studies and to test the null...
The aim of the study is to determine the reliability of the Tulipan-Ilyas (TI) classification among hand surgeons by utilizing several case studies and to test the null hypothesis that the TI system would have superior interobserver reliability than the Gustilo-Anderson (GA) system for classifying and guiding treatment for open fractures of the hand. Institutional review board exemption for this study was confirmed. All surgeons were unaware and blinded to the development and origin of the newly proposed TI classification system. Interobserver reliability was computed using the multi-rater κ described by Fleiss. The κ values were interpreted according to the guidelines of Landis and Koch. Interrater reliability was computed utilizing methods described by Shrout and Fleiss. The overall κ value for interobserver reliability was 0.339 (95% confidence interval [CI], 0.304-0.376) for the GA classification and 0.443 (95% CI, 0.423-0.463) for the TI classification, indicating fair and moderate agreement, respectively. According to the intraclass correlation coefficients, the interrater agreement for average measures for both classification systems was excellent, with intraclass correlation coefficient (ICC) values, including the lower CIs, all greater than 0.91. However, for the ICCs for single measures, generalizing only to one rater, the interrater agreement for the GA classification (0.595, 95% CI, 0.387-0.836) was only good, but for the TI classification system was excellent (0.958, 95% CI, 0.912-0.987). The authors recommend the TI classification instead of the GA classification system for use in open fractures of the hand because of its superior interobserver reliability and its hand-specific nature.
Topics: Fractures, Open; Humans; Observer Variation; Reproducibility of Results
PubMed: 30947561
DOI: 10.1177/1558944719840738 -
BMC Musculoskeletal Disorders Mar 2023Trauma is now one of the fastest growing epidemics globally but low and middle-income countries (LMICs) are more severely affected in terms of cost, disability and... (Observational Study)
Observational Study
Locked intramedullary nailing of open fractures in resource-poor settings: a prospective observational study of challenges and functional outcomes in 101 fractures at Ogbomoso, Nigeria.
BACKGROUND
Trauma is now one of the fastest growing epidemics globally but low and middle-income countries (LMICs) are more severely affected in terms of cost, disability and death. The high-energy trauma of road traffic accidents and violence often produces open fractures which can be difficult to manage in resource-poor settings. Adequate stabilization, such as provided by locked nails, has been found to ensure better outcome for open fractures. There is dearth of published studies on the use of locked intramedullary nail in the treatment of open fractures in Nigeria.
METHODS
This is a prospective observational study of all the 101 open fractures of the humerus, femur and tibia treated over a period of 92 months with Surgical Implant Generation Network (SIGN) nail. Fracture severity was classified according to the modified Gustilo-Anderson system. The intervals between fracture and antibiotics administration, débridement and definitive fixation, as well as surgery duration and method of fracture reduction were noted. Outcomes measured at follow-up included infection, ongoing radiographic healing, knee flexion/shoulder abduction beyond ninety degrees (KF/SA > 90), full weight bearing (FWB), painless squatting (PS&S)/shoulder abduction-external rotation (SAER).
RESULTS
Most of the patients fall between ages 20 and 49 years; 75.5% of them were males. There were more Gustilo-Anderson type IIIA fractures than other types but nine type IIIB tibia fractures were also nailed. The overall infection rate was 15%, contributed mostly by the type IIIB fractures. By the 12th post-operative week, at least 79% had ongoing radiographic healing and had achieved all of KF/SA > 90, FWB, and PS&S/SAER.
CONCLUSION
The SIGN nail's solid construct reduces the risk of infection and allows earlier use of the limb, making it particularly suitable in LIMCs where socioeconomic functioning often requires an unhindered use of the limbs.
Topics: Male; Humans; Young Adult; Adult; Middle Aged; Female; Fractures, Open; Fracture Fixation, Intramedullary; Nigeria; Extremities; Internal Fixators
PubMed: 36882725
DOI: 10.1186/s12891-023-06271-7 -
Acta Orthopaedica Et Traumatologica... 2012The aim of this study was to evaluate the results and complications of free vascularized fibular grafting (FVFG) for the reconstruction of bone defects in Gustilo Type 3...
OBJECTIVE
The aim of this study was to evaluate the results and complications of free vascularized fibular grafting (FVFG) for the reconstruction of bone defects in Gustilo Type 3 open tibia fractures.
METHODS
Free vascularized fibular grafting was performed on open tibia fractures with a bone defect of an average of 10 (range: 6 to 18) cm in 21 patients (19 males, 2 females; mean age: 32 years; range: 16 to 47 years). Primary FVFG was performed for 15 patients with open fractures and secondary FVFG in 6 patients with osteomyelitis due to open fractures or defective nonunions. Bony unions were evaluated retrospectively. At a mean follow-up time of 74 (range: 18 to 216) months, 18 patients were examined for malalignment, shortness, and range of motion. Quality of life was evaluated using the Short Form 36 (SF-36).
RESULTS
Mean bony union times for the proximal and distal fibula were 19 (range: 16 to 24) weeks and 20 (range: 16 to 28) weeks, respectively. Proximal nonunion was detected in three patients. Mean external fixation removal time was 6.3 (range: 3 to 14) months. Stress fractures occurred in 15 patients following fixator removal. Malalignment of over 5 degrees was detected in 7 patients and shortness over 2 cm was detected in 4 patients. SF-36 scores were significantly lower in the domains of physical functioning, role limitation due to physical problems, bodily pain, general perception of health, social function, and role limitation due to emotional problems. Mental health, energy and vitality were similar to the healthy reference group.
CONCLUSION
Free vascularized fibular grafting appears to be a reliable and effective method for reconstructing bone defects and soft tissue defects in a single session in open tibia fractures.
Topics: Adolescent; Adult; Bone Transplantation; External Fixators; Female; Fibula; Fractures, Open; Graft Survival; Humans; Male; Middle Aged; Orthopedic Procedures; Osteomyelitis; Plastic Surgery Procedures; Soft Tissue Injuries; Surgical Flaps; Tibial Fractures; Treatment Outcome; Young Adult
PubMed: 23428767
DOI: 10.3944/aott.2012.2876 -
Journal of the American Veterinary... Sep 2014To evaluate the proportion of and risk factors for open fractures of the appendicular skeleton in dogs and cats that were a result of acute trauma.
OBJECTIVE
To evaluate the proportion of and risk factors for open fractures of the appendicular skeleton in dogs and cats that were a result of acute trauma.
DESIGN
Cross-sectional and case-control study.
ANIMALS
84,629 dogs and 26,675 cats.
PROCEDURES
Dogs and cats examined at Purdue University Veterinary Teaching Hospital from January 1993 through February 2013 were identified; the proportion of open fractures was estimated from the medical records. Additionally, all incident cases of open (77 dogs and 33 cats) and closed (469 dogs and 80 cats) fractures between January 1993 and February 2013 and a random sample of nonfracture patients (722 dogs and 330 cats) in 2010 were used to assess risk factors for open appendicular fractures.
RESULTS
Proportion of open fractures for the 20-year period was 0.09% (95% confidence interval [CI], 0.07% to 0.11%) in dogs and 0.12% (95% CI, 0.09% to 0.17%) in cats. Seventy-seven of 546 (14.1%) and 33 of 113 (29.2%) traumatic fractures were classified as open in dogs and cats, respectively. Comminuted fractures were more likely than other configurations to be open in dogs (OR, 5.9; 95% CI, 2.9 to 12.2) and cats (OR, 3.5; 95% CI, 1.0 to 12.0). Vehicle-related trauma was a significant risk factor for open fractures in dogs (OR, 13.8; 95% CI, 3.1 to 61.8).
CONCLUSIONS AND CLINICAL RELEVANCE
The proportion of incident open fractures in dogs and cats was low. Age, body weight, affected bone or bone segment, fracture configuration, and method of trauma were associated with an open fracture.
Topics: Animals; Case-Control Studies; Cat Diseases; Cats; Cross-Sectional Studies; Dog Diseases; Dogs; Extremities; Female; Fractures, Open; Male; Odds Ratio; Retrospective Studies
PubMed: 25181270
DOI: 10.2460/javma.245.6.663