Comparative accuracy assessment of the Gustilo and Tscherne classification systems as predictors of infection in open fractures

Oliveira, Rafael Valadares; Cruz, Luciano Passos; Matos, Marcos Almeida

doi:10.1016/j.rboe.2018.03.005

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…In the current study, the percentage of early infections (first 7 days) was 7.4%, results that differ from those of other studies from the national literature, which found percentages of 13.24%, 18.80%, and 23.7% for open fractures in general (18)(19)(20) , and most infections were observed in open fractures classified as Gustilo and Anderson type III (18)(19)(20)(21)(22) . It is inferred that our results were lower than those observed in the literature due to the higher percentage of less severe fractures in the current study (42% of Gustilo and Anderson type II open fractures); additionally, most study were prospective, with follow-up duration longer than 6 weeks (18)(19)(20)(21)(22) . In the study with the highest percentage of infections (23.7%), it was found that this high percentage was associated with severity of soft tissue injuries and delayed orthopedic treatment (22) .…”

Section: Discussioncontrasting

confidence: 99%

“…In order to minimize the risk for infection, timely treatment is performed with complete debridement, in which all foreign bodies and contaminated tissues, or those with suspected avascularization, are systematically removed, and death spaces and hematomas are minimized (13,(17)(18)(19)(20)(21)(22) .…”

Section: Discussionmentioning

confidence: 99%

“…Patients underwent safe skeletal stabilization, with the recovery of limb length, a measure that enable to reestablish the appropriate soft tissue tension, in addition to improving circulation and facilitate venous and lymphatic return, thus favoring edema reduction (13,(17)(18)(19)(20)(21)(22) .…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological study of open fractures of the ankle and foot

et al. 2021

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Objective: To characterize the epidemiological profile of patients treated at a hospital service with diagnosis of open fracture of the ankle and foot. Methods: Retrospective, descriptive, epidemiological, observational study of open fractures of the ankle and foot selected by convenience sampling in a hospital service in São Paulo, state of São Paulo, Brazil, from March 1, 2017, to March 1, 2019, totaling 109 patients. Data collection was conducted for the analysis of variables included in patients’ medical records. Results: The medical records of 700 patients with open fractures were assessed. Of these patients, 13.2% (109 patients) had open fractures of the ankle and foot. There was a predominance of male young adults (70.8%) and of left lower limb fractures (51.85%). Most cases were classified as Gustilo and Anderson type II fractures (42.6%). Motorcycle accidents (44.45%) predominated, and students and professional motorcyclists were the most frequent occupations (37.04%). The most adopted stabilization method was osteosynthesis (internal fixation) (44.45%), and primary amputation was required in 3.7% of the cases. Conclusion: Male young adults were the most affected by fractures of the ankle and foot, and traffic accidents were the leading cause. Most patients had an educational attainment of complete elementary education. Most fractures were classified as Gustilo and Anderson type II. Greater severity was observed in patients with associated injuries in other body segments and who developed early complications during hospitalization. Level of Evidence IV; Prognostic Studies; Case Series.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Epidemiological study of open fractures of the ankle and foot

et al. 2021

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“…The classification of wounds based on the Gustilo-Anderson system may not entirely reflect the true extent of soft-tissue damage and contamination caused by the missile and may be influenced by various factors such as times to presentation and to irrigation and debridement 10 . This system also exhibits limitations in terms of interobserver reliability and validity for open injuries caused by gunshot wounds 48 , 49 . Similarly, the classification of fractures using the OTA/AO system based on radiographs and operative findings may not capture the full spectrum of fracture patterns and variations caused by gunshot wounds and may be influenced by factors such as image quality, displacement, or reduction 50 , 51 .…”

Section: Discussionmentioning

confidence: 99%

Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen

Hutaif,

Al-Moaish,

Al-fadliy

2024

JBJS Open Access

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Background: Open proximal femoral fractures caused by gunshot wounds are rare but devastating injuries that pose considerable challenges for prognosis and management. The aim of this study was to evaluate the functional and radiographic outcomes of patients with open proximal femoral fractures caused by gunshot wounds treated at 3 Level-I trauma centers in Yemen and to identify the factors that influence them. Methods: We prospectively enrolled 174 patients with open proximal femoral fractures caused by gunshot wounds. The fractures were classified according to the Gustilo-Anderson and OTA/AO systems. The primary outcome measures were fracture union, infection, and functional outcomes. The secondary outcome measures were the Harris hip score (HHS) and the Short Form-36 (SF-36) health survey score. We performed multivariable logistic regression modeling to identify the predictors of complications and poor functional outcomes. Results: The overall rate of fracture union was 87%. The complication rates were 18% for infection, 13% for nonunion, 23% for reoperation, 12% for delayed union, 4% for osteonecrosis, 6% for heterotopic ossification, and 2% for amputation. The mean HHS at the final follow-up was 78.4, and the mean SF-36 score was 67.3. Conclusions: Open proximal femoral fractures caused by gunshot wounds are associated with high rates of complications and poor functional outcomes in Yemen. Early debridement, appropriate fixation, infection control, and adequate soft-tissue coverage are essential for achieving satisfactory results. The type of wound, the type of fracture, and the type of definitive fixation are significant predictors of the outcomes. Future studies should compare different fixation methods and evaluate the long-term outcomes and complications of these injuries. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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“…Las fracturas de las extremidades inferiores se encuentran entre las lesiones más frecuentes en pacientes con politraumatismos y con frecuencia son responsables de hospitalizaciones, discapacidad crónica y deterioro funcional (7). Ocurren con mayor frecuencia en la tibia, su prevalencia varía del 20% al 40% de los casos, seguida de las que ocurren en el fémur (12%), metacarpianos y ulna (8).…”

Section: Epidemiologíaunclassified

Manejo de fracturas Abiertas

Méndez

2020

Rev.méd.sinerg.

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Las fracturas abiertas se caracterizan por la pérdida de la continuidad ósea y la exposición del foco de fractura con el medio externo, situación que las hace especialmente vulnerables a procesos infecciosos y múltiples complicaciones. La mayoría de fracturas abiertas son causadas por traumatismos de alta energía; ocurriendo más en hombres y siendo la tibia el hueso que se afecta con mayor frecuencia. Se clasifican según el mecanismo de lesión, la gravedad de lesión de los tejidos blandos, la configuración de la fractura y el grado de contaminación; siendo la más utilizada la clasificación de Gustilo y Anderson por su utilidad terapéutica. Los objetivos principales del tratamiento son prevenir la infección, estabilizar la fractura, conseguir la consolidación y restaurar la función; para ello es indispensable la instauración de una profilaxis antibiótica y un manejo adecuado de los tejidos blandos.

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Comparative accuracy assessment of the Gustilo and Tscherne classification systems as predictors of infection in open fractures

Cited by 7 publications

References 22 publications

Epidemiological study of open fractures of the ankle and foot

Epidemiological study of open fractures of the ankle and foot

Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen

Manejo de fracturas Abiertas

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