Open hand fractures: Prognosis and classification

Swanson, Todd V.; Szabo, Robert M.; Anderson, Daniel

doi:10.1016/s0363-5023(10)80021-8

Cited by 78 publications

(41 citation statements)

References 18 publications

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“…We do not propose an explanation for our incidence of infection being substantially lower than their clinical experience. Analysis of our infections were actually more comparable to Swanson and McLain's studies of open hand fractures, which emphasized contamination over wound severity as a predictor of infection [7,11]. Therefore, we similarly recommend a classification of open distal radius fractures (such as that of Swanson et al) that emphasizes contamination over the extent of soft tissue injury [11].…”

Section: Discussionsupporting

confidence: 75%

“…Swanson et al also addressed open hand fractures and proposed a new classification for open hand fractures with an emphasis upon contamination [11]. Their study found a distinct difference between the prognosis and treatment of open hand fractures and open long bone fractures.…”

Section: Discussionmentioning

confidence: 99%

“…This may be due to the relatively greater blood supply to this region compared to the lower extremity [1,12]. Two studies addressing open fractures of the hand found a more direct correlation of infection with wound contamination than wound size or extent of soft tissue injury [7,11]. Swanson et al proposed a new classification incorporating contamination, duration, and systemic illness ( Table 2) to predict infection [11].…”

mentioning

confidence: 99%

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Factors Associated with Infection following Open Distal Radius Fractures

Glueck¹,

Charoglu²,

Lawton³

2009

Hand (New York, N,Y.)

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Open fractures are often classified according to a system described by Gustilo and Anderson. However, this system was applied to open long bone factures, which may not predict the incidence of infection in open metaphyseal fractures of the upper extremity. Other studies have found that wound contamination and systemic illness were the best predictors of infections in open hand fractures. Our study assessed infection in open distal radius fractures and identifies factors that are associated with these infections. We hypothesize that contamination, rather than absolute wound size, is the best predictor of infection associated with open distal radius fractures. A review by CPT code yielded 42 patients with open distal radius fractures between 1997 and 2002 treated at a level one trauma center. Medical records and radiographic follow-up were reviewed to assess the time to irrigation and debridement, the number of debridements in initial treatment period, the method of operative stabilization, the Gustilo and Anderson type of fracture, the Swanson type of fracture, and description of wound contamination. Forty-two patients were followed up for an average of 15 months (range 4 to 68 months). Twentyfour fractures were classified as Gustilo and Anderson type I, ten were type II, and eight were type III, 30 were Swanson type I, and 12 were Swanson type II. Five of the 42 fractures were considered contaminated. Two were exposed to fecal contamination. The others were contaminated with tar, dirt/ grass, and gravel, respectively. Three of 42 (7%) fractures developed infections. All three infected cases received a single irrigation and debridement. Two of five contaminated fractures (40%) developed a polymicrobial infection. Both were exposed to fecal contamination and, therefore, considered Swanson type II fractures. They were classified as Gustilo and Anderson type II and IIIB based solely upon the size of the wound. Both required multiple debridements and eventually wrist fusions. The third infection occurred in a Gustilo and Anderson type II and Swanson type I open fracture treated with one debridement and plate fixation. Hardware removal, debridement, and antibiotics resolved the infection. Three contaminated fractures that healed uneventfully received two debridements. Statistical analysis revealed a correlation with infection and contamination (p=0.0331). The number of initial debridements played a role in infection, but was not statistically significant. No relationship between infection and time to initial irrigation and debridement, method of fixation, Gustilo and Anderson type, or Swanson type was found. We propose that open distal radius fractures behave differently than open long bone fractures. Infection developed in 7% of the distal radius fractures in our study and was significantly associated with wound contamination. We recommend that contamination be included as factor for prognosis in open distal radius fractures. Contaminated fractures should be treated with multiple debridements as part of the ...

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Factors Associated with Infection following Open Distal Radius Fractures

Glueck¹,

Charoglu²,

Lawton³

2009

Hand (New York, N,Y.)

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“… Swanson had rightly said -hand fracture can be complicated by deformity from no treatment: stiffness from over treatment and both deformity and stiffness from poor treatment. 4 …”

Section: Incidencementioning

confidence: 99%

Functional Outcome of Open Phalangeal and Metacarpal Fractures Treated With External Fixation

Kannan¹,

Palaniappan²,

Srinivasan³

et al. 2016

jemds

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MATERIALS AND METHODSThe common age group affected was 21-30 years with mean age being 35.5 years (13-60 years). Most of the injuries were caused by industrial accidents (57.6%). In 34.6% of cases, the dominant hand was involved. All patients were treated with wound debridement, external fixation and early mobilisation of the fingers. The follow-up period ranged between 2.3 -8.2 years (mean 4.4 years). Complications occurred in ten fractures. Loosening of the pin (6) was the most common complication. Except two, all the fractures healed. RESULTSThe functional recovery was analysed using the American Society for Surgery of the Hand (ASSH) criteria of TAM. Results were good or excellent in 86.7% of metacarpal fractures and in 85.7% of Phalangeal fractures with overall result of about 85.9%. Poor results occurred in about 14.1% fractures. Majority of these cases had multiple fractures or accompanied with severe soft tissue injuries. CONCLUSIONTo conclude external fixation is an adequate alternative treatment for unstable open Phalangeal and metacarpal fractures, which are accompanied by severe soft tissue injuries.

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“…In case of head injury, the surgical procedure was delayed till the patient recovered from head injury. With the present study, open fractures were classified according to Swanson et al 3 In our study by following Swanson et al classification, there were 4 cases of type I (13.33%) and 5 cases of type II (20%). No injury with vascular impairment was noted.…”

Section: Number Percentagementioning

confidence: 78%

Functional Outcome Evaluation of Phalangeal and Metacarpal Fractures Treated With Jess Fixation

S¹,

K²

2018

jebmh

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BACKGROUNDFractures of metacarpals and phalanges are the most common fractures of the upper extremity and account for 10% of total such cases. The outer rays of the hand are most commonly injured. The incidence of metacarpal and phalangeal fractures is most common in males and peaks at the age of 10-40 years a time when the athletic injury and industrial exposure is the greatest. Unfortunately, the metacarpal and phalangeal fractures are often neglected or regarded as trivial injuries. The Proximal Phalanx (PP) of the fingers, fractures are more frequently than the middle or distal phalanges. The deformity with considerable displacement is typical when the PP is fractured. Most fractures are functionally stable either before or after Closed Reduction (CR) and fare well with protective splint and early mobilisation. Closed treatment has gained a poor reputation in unstable comminuted, juxtaarticular and open fractures because of problems of malunion, stiffness and sometimes loss of skin or other soft tissues. Open reduction and internal fixation with K wires, plates and screws further compromises injured soft tissues and leads to infection and stiffness. On the other hand, external fixation allows fracture reduction to normal bone length via a rigid external support. Stiffness can be prevented by mobilisation of joints proximal and distal to the fracture.

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Open hand fractures: Prognosis and classification

Cited by 78 publications

References 18 publications

Factors Associated with Infection following Open Distal Radius Fractures

Factors Associated with Infection following Open Distal Radius Fractures

Functional Outcome of Open Phalangeal and Metacarpal Fractures Treated With External Fixation

Functional Outcome Evaluation of Phalangeal and Metacarpal Fractures Treated With Jess Fixation

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