Irrigation of the wounds in open fractures

Crowley, Daniel J.; Kanakaris, Nikolaos K.; Giannoudis, Peter V.

doi:10.1302/0301-620x.89b5.19286

Cited by 135 publications

(89 citation statements)

References 38 publications

(116 reference statements)

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“…As previously discussed (54,55), early removal of foreign bodies and organic contaminations (56) accompanied by early irrigation and debridement in the first 24 hours play a crucial role in improving the outcome of open fractures (57,58). Our unpleasant experience throws the light on this fact that if the wound has been primary closed or approximated, wound reassess mentation is important.…”

Section: Infectionmentioning

confidence: 94%

Muskuloskeletal Related Injuries After 2017 Kermanshah Earthquak: A Literature Review

Mortazavi¹,

Ebrahiminasab²,

Farhoud³

et al. 2017

J Orthop Spine Trauma

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Objectives: This study aims to investigate the pattern of Musculoskeletal and soft tissue injuries in a series of referred patients in a tertiary medical center and review previous reports in the literature. Methods: In this study, we recorded musculoskeletal injuries of the victims, following the Kermanshah earthquake on November 12, 2017, with a total number of 38. All patients were admitted to the Imam Khomeini Hospital. Injury type, site of injury, gender, age, complications, mortality, and treatment modality were recorded for each case.Results: Among 38 patients, 18 were male (47%) and 20 were female (53%). The mean age was 37 ± 21.6 years. Most of them were aged between 18 and 65 (71.1%). Lower extremities were involved more than the upper (37% versus 24%) and distal limb involvement was more than the proximal (57.3% versus 43.7%). One patient died due to necrotizing fasciitis and septic shock after femoral shaft open fracture. Two patients developed compartment syndrome and underwent fasciotomy complications by skin necrosis and infection. Conclusions: Soft tissue injuries and fractures are the most common injuries following the earthquakes, hence orthopedic surgeries play a vital role in disasters. Despite patients overload and emergency situation in natural disasters like earthquakes, it is crucial to have a stepwise and evidence based approach for each patient. For the patients with open fractures referred to a tertiary center, careful contamination assessment even in the previously managed wounds is highly recommended, especially for those with early wound closure. Early fasciotomy in the crush syndrome is not beneficial as it has adverse effects such as skin necrosis and infection.

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Section: Infectionmentioning

confidence: 94%

Muskuloskeletal Related Injuries After 2017 Kermanshah Earthquak: A Literature Review

Mortazavi¹,

Ebrahiminasab²,

Farhoud³

et al. 2017

J Orthop Spine Trauma

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“…22 Lastly, an extensive literature review by Crowley, investigating the time to debridement, showed that the 6 hour rule needs to be re-evaluated. 23 …”

Section: Trauma-surgery Intervalmentioning

confidence: 99%

Extended use of limb reconstruction system in management of compound tibia diaphyseal fracture as primary and definitive tool

Mahajan

Mangukiya

2017

Int J Res Orthop

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INTRODUCTIONOpen fractures of tibia remain a formidable injury in today's motorized society for two reasons -they are common and they can be very challenging fractures to unite with good functional outcome. It has been predicted that more than 4.5 million open fractures occur per year in India as compared to 3.5-6 million fractures occur in the United states annually. 1,2The tibia being the most commonly fractured long bone as one-third of its surface is subcutaneous, open fractures are more common in tibia than in any other major long bones and its fracture management has changed drastically from conservative to early surgical management and its fracture management contributes significantly to the cost of orthopaedic care being provided worldwide.3,4 Epidemiological studies suggest that motor vehicle accidents are the most common causes of tibial diaphyseal fractures, followed by sports-related injuries.2 High energy trauma which imparts more kinetic ABSTRACT Background: The fractures of the tibia are among the most difficult fractures to treat effectively. The status of the soft tissues, the degree of comminution and level of contamination sustained at the time of injury affect the long term clinical results. The goal of operative treatment is to obtain anatomic realignment of the shaft of tibia while providing enough stability to allow early motion. This should be accomplished using techniques that minimize osseous and soft tissue devascularization in the hopes of decreasing the complications resulting from treatment. Methods: A prospective randomized study was conducted between 2014-2016 on 20 patients admitted with compound tibia diaphyseal fracture and treated with Limb reconstruction surgery. Results: In our study, the mean time of partial weight bearing was 3.5±2.97 weeks, full weight bearing was 8.55± 4.14 weeks and bone union time was 20.22±5.22 weeks. The pin tract infection was found in 5 (25%) cases. Delayed union was observed 06 (30%) cases. Shortening of more than 2 cm were recorded in 3 (15%) patients. Joint (knee or ankle) stiffness was observed in 6 (30%) cases. Loosening of pin was observed in 3 (15%) cases. Chronic osteomyelitis was observed in 3 (15%) cases. Secondary procedures were done in 11 (55%) cases. Bone marrow aspiration was done in 5 (25%) cases, iliac bone grafting in 5 (25%) cases. Conclusions: LRS is found to be wonderful tool in management of compound tibia fractures as primary and definitive mode because of its safety, versatile nature, patient friendly and cost effectiveness.

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“…In contrast the antibiotic group had significantly higher energy injuries and this group also had a longer follow up. Another bias in the study was the lack of a control group with warm Normal Saline which is regarded as the solution of choice in lavage (20). Several studies proved that high pressure lavage significantly reduces the bacterial load, but at the same time is associated with significant bone damage (20).…”

Section: Debridement and Lavagementioning

confidence: 99%

“…Another bias in the study was the lack of a control group with warm Normal Saline which is regarded as the solution of choice in lavage (20). Several studies proved that high pressure lavage significantly reduces the bacterial load, but at the same time is associated with significant bone damage (20). Therefore, low pressure lavage should be used which is safe and effective in reducing the infection rate (21).…”

Section: Debridement and Lavagementioning

confidence: 99%