The management of open fractures.

Gustilo, Ramon B.; Merkow, Robert L.; Templeman, David C.

doi:10.2106/00004623-199072020-00023

Cited by 571 publications

(309 citation statements)

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“…It involves early wound debridement with copious irrigation, prompt initiation of intravenous antibiotics, good coverage for the bone and soft tissue, as well as adequate, rigid stabilisation. [1][2][3][4][5][6][7][8][9][10] We aimed to determine the role of qualitative cultures (both pre-and post-debridement) in detecting infections in open tibial fractures, and to highlight any correlation between infections and other variables (age, sex, interval to debridement, cause of fracture, and the Gustilo classification).…”

Section: Introductionmentioning

confidence: 99%

The Use of Qualitative Cultures for Detecting Infection in Open Tibial Fractures

D'Souza

Rajagopalan

Amaravati

2008

J Orthop Surg (Hong Kong)

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Section: Introductionmentioning

confidence: 99%

The Use of Qualitative Cultures for Detecting Infection in Open Tibial Fractures

D'Souza

Rajagopalan

Amaravati

2008

J Orthop Surg (Hong Kong)

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“…The consequences for the patients in case of a postoperative osteomylitis are catastrophic, leading to implant removal, prolonged hospitalization, failure of the implant, possible amputation or even death [12,14]. The occurrence of local infection is influenced by multiple biological and implant factors such as vascularity, tissue necrosis, in addition to implant design, implant material and implantation technique.…”

Section: Introductionmentioning

confidence: 99%

Infection resistance of unreamed solid, hollow slotted and cannulated intramedullary nails: An in‐vivo experimental comparison

Horn

Schlegel

Krettek

et al. 2005

Journal Orthopaedic Research

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Infection continues to be a problematic complication of fracture treatment, particularly in severe open fractures. The implant design and material as well as implantation technique play an important role in the pathogenesis of local infection. The aim of our study was to determine if the local resistance to infection of a cannulated IM nail is less than that of a solid nail and more similar to that of a hollow nail. In 65 female White Zealand rabbits, the intramedullary cavity was inoculated with matching concentrations of Staphylococcus aureus, and one of the three nails was inserted. The solid nail had a greater than twofold higher resistance to infection (23%) compared to that of the other two nails (hollow, 65%; cannulated, 61%) which was statistically significant (p < 0.02). No difference in infection resistance was detected between the hollow slotted and cannulated nail designs 0, = 1). Although these experimental results may be clinically considered, direct extrapolation to clinical infection rates is ill advised.

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“…We retrospectively reviewed 39 cases of grade IIIA [4] open tibial diaphysial fractures in children up to the age of 13 years, presenting to seven hospitals in the northwest of England and identified from the hospitals' information system via a computer search. They were all treated between January 1992 to January 2001, although the exact number of years examined varied amongst hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…There seems to be an agreement that low-energy, Gustilo [4] grade I fractures can be treated with casting, and that grade IIIB tibial fractures which require plastic procedures to achieve periosteal coverage should be treated by surgical fixation. However, there is no consensus with regard to the management of grade IIIA injuries, that is high-energy or very contaminated open tibial fractures where periosteal coverage is adequate.…”

Section: Introductionmentioning

confidence: 99%

Casting versus surgical fixation for grade IIIA open tibial diaphysial fractures in children: effect on the rate of infection and the need for secondary surgical procedures to promote bone union

Charalambous

Alvi

Siddique

et al. 2005

International Orthopaedics (SICO

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We evaluated 39 grade IIIA open tibial fractures presenting in children younger than 13 years of age, to determine if the mode of fracture stabilization (casting vs. surgical fixation) was related to the rate of infection or the need for secondary surgical procedures to promote bone union. All fractures had wound debridement in the operating room. Thirty patients had manipulation and casting, and nine surgical internal or external fixation. There were two cases of infection in the cast-treated group and two in the surgical fixation group (P=0.17). None of the fractures required a secondary surgical procedure to promote bone union. Three of the fractures treated by manipulation and casting displaced; two required re-manipulation and casting and one was converted to external fixation. In two cases the applied external fixator had to be re-aligned. Our results suggest that manipulation and casting is a reliable treatment for open tibial fractures in children.Résumé Nous avons évalué 39 fractures tibiales ouvertes niveau IIIA survenues chez des enfants de moins de 13 ans, pour déterminer si le mode de stabilisation de la fracture (plâtre contre fixation chirurgicale) a été en rapport avec le taux d'infection ou la nécessité d'interventions chirurgicales secondaires pour obtenir la consolidation. Toutes les fractures avaient un parage en salle d'opération. Trente malades avaient une réduction suivie d'un plâtre, et neuf une fixation chirurgicale interne ou externe. Il y avait deux cas d'infection dans le groupe traité par plâtre et deux dans le groupe fixation chirurgicale (P=0,17). Aucun des fractures n'a nécessité une intervention chirurgicale. Trois fractures traitées par plâtre se sont déplacées, avec nouvelle réduction et plâtre pour deux, et utilisation d'un fixateur externe pour la troisième. Dans deux cas les fixateurs externes ont du être réalignés. Nos résultats suggèrent que le traitement orthopédique par réduction et plâtre est un traitement fiable pour les fractures tibiales ouvertes chez les enfants.

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The management of open fractures.

Cited by 571 publications

References 0 publications

The Use of Qualitative Cultures for Detecting Infection in Open Tibial Fractures

The Use of Qualitative Cultures for Detecting Infection in Open Tibial Fractures

Infection resistance of unreamed solid, hollow slotted and cannulated intramedullary nails: An in‐vivo experimental comparison

Casting versus surgical fixation for grade IIIA open tibial diaphysial fractures in children: effect on the rate of infection and the need for secondary surgical procedures to promote bone union

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