Timing of Operative Debridement in Open Fractures

Rozell, Joshua C.; Connolly, Keith P; Mehta, Samir

doi:10.1016/j.ocl.2016.08.006

Cited by 20 publications

(15 citation statements)

References 49 publications

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“…All patients underwent standardized wound debridement, antibiotic coverage, fracture fixation, elective debridement when required, and early wound coverage. 12 Postoperatively, most patients underwent standard wound care and negative pressure wound management only for those specifically implicated by the operating surgeon. Immediate, early, and delayed wound cover was purely the surgeon’s discretion.…”

Section: Methodsmentioning

confidence: 99%

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Time to debridement in open high-grade lower limb fractures and its effect on union and infections: A prospective study in a tropical setting

Joseph

Jepegnanam

Ramasamy

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: To prospectively evaluate whether time to debridement has any correlation with union, infection, and quality of life in high-grade lower limb fractures in a tropical setting. Methods: A prospective cohort study was conducted at a tertiary care center in South India. Two hundred fifty-four adult skeletally mature patients with 301 grade 3 fractures involving the femur, tibia, or fibula were recruited. The cohort was empirically divided into two groups (early and late) based on the time to debridement (less than or more than 12 h from injury). Outcome: The primary outcome was nonunion. Secondary outcomes were deep infection rates and patients’ quality of life. Short form-36 (SF-36) and short musculoskeletal functional assessment (SMFA) questionnaires were also used. Patients were followed up for 9 months. Results: The follow-up rate was 93%. The late group had a significantly higher risk of nonunion (odds ratio(OR): 6.5, 95% confidence interval (CI): 2.82–14.95) and infections (OR: 6.05, 95% CI: 2.85–12.82). There was a 4% increase in the infection risk for each hour of delay for the initial 50 h ( p < 0.0001). SF-36 and SMFA scores were superior in the early group ( p < 0.0001). Conclusion: The study contradicts findings reported in the literature from the West. Our study was in agreement with our hypothesis and proved that debridement within 12 h resulted in significantly lower rates of nonunion and infections and an overall improved quality of life in high-grade open lower limb fractures in a developing country. Level of evidence: Level II Trial registration: German Clinical Trials Register DRKS00015186

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Section: Methodsmentioning

confidence: 99%

“…Immediate, early, and delayed wound cover was purely the surgeon's discretion. 12,13 The cohort was empirically Journal of Orthopaedic Surgery 28 (1) divided into two groups (early and late) based on the time to debridement (less than or more than 12 h from injury).…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Time to debridement in open high-grade lower limb fractures and its effect on union and infections: A prospective study in a tropical setting

Joseph

Jepegnanam

Ramasamy

et al. 2020

J Orthop Surg (Hong Kong)

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“…With that said, it would stand to reason therefore that normal saline at low pressure would be a sensible initial intervention in ED also, even if the process will be repeated in theatre. 30 Preliminary irrigation in the emergency department has been proposed before, however opinion remains mixed; with some studies advocating this practice and others suggesting it may do more harm than good, by pushing infection deeper into the wound. No further studies relating to this topic have been identified since 2017.…”

Section: Boast-4mentioning

confidence: 99%

“…The multidisciplinary orthoplastic approach to open injuries is arguably one of the most impactful changes brought forward by the 2009 BOAST-4 guidance. The introduction of BOAST-4 has been shown to improve outcomes, 30,32 and this novel MDT and trauma system based approach is thought to be partly responsible. 33e36 The argument for aiming to provide treatment as soon as possible by an expert team during day-time hours, rather than be hampered by a poor first attempt at night by an inexperienced orthopaedic surgeon alone.…”

Section: Boast-4mentioning

confidence: 99%

“…33e36 The argument for aiming to provide treatment as soon as possible by an expert team during day-time hours, rather than be hampered by a poor first attempt at night by an inexperienced orthopaedic surgeon alone. 30 2017 BOAST-4 guidance however takes a step away from this, by setting a new 12 h target for high energy injuries. This may be wellintentioned, however it may inadvertently lead to a step backwards in this respect.…”

Section: Boast-4mentioning

confidence: 99%

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The evidence base for 2017 BOAST-4 guidance on open fracture management: Are we due an update?

Ibrahim

Jamal

Akhtar

2021

Journal of Clinical Orthopaedics and Trauma

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Introduction: Open fracture management in the United Kingdom and several other countries is guided by the British Orthopaedic Association's Standards for Trauma Number 4 (BOAST-4). This is updated periodically and is based on the best available evidence at the time. The aim of this study is to evaluate the evidence base forming this guidance and to highlight new developments since the last version in 2017. Methods: Searches have been performed using the PubMed, Embase and Medline databases for time periods a) before December 31, 2017 and from 01/01/2018e01/02/2021. Results have been summarized and discussed. Discussion: Several contentious issues remain within the 2017 guideline. Antibiotic guidance, the use of antibiotic impregnated PMMA beads and intramedullary devices, irrigation in the emergency department, time to theatre and the use of negative pressure dressings and guidance regarding the management of paediatric injuries have all demonstrated no clear consensus. Conclusion:The advent of the BOAST-4 guideline has been of huge benefit, however the refinement and improvement of this work remains ongoing. There remains a need for further study into these contentious issues previously listed.

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Go with the flow: An experimental analysis with tubing alternative with irrigation

Hyland

DeGenova

Scheschuk

et al. 2023

Health Science Reports

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Background and Aims: Literature regarding alternative tubing for fluid delivery in irrigation and debridement procedures is lacking. The purpose of this study was to compare three different apparatuses with varying quantities of irrigation fluid to assess efficiency of administration and evaluate overall time for fluid administration. Methods: This model was designed to compare available methods of gravity irrigation used in practice. Fluid flow time was measured for three types of tubing: single-lumen cystoscopy tubing, Y-type double-lumen cystoscopy tubing, and nonconductive suction tubing. Irrigation times were assessed for varying volumes of 3, 6, and 9 L to investigate the relationship between bag changes and irrigation time. Bag changes were not conducted for the 3 L trial, but were for 6 and 9 L trials. Dimensions of cystoscopy tubing consisted of 4.95 mm internal diameter and 2.1 m length in both single-lumen and Y-type double-lumen apparatus. Nonconduction suction tubing dimensions were 6.0 mm internal diameter and standard 3.7 m in length. Results:The mean flow time for suction tubing was significantly faster than the cystoscopy tubing for the 3 and 9 L trials (p < 0.001). At 6 L, flow time for the suction tubing and the double lumen cystoscopy tubing were similar, 264 versus 260 s, respectively. At 9 L, the mean flow time for the suction tubing was 80 s faster (410 vs. 491 s) compared with single-lumen cystoscopy and was nearly 30 s faster compared with Y-type cystoscopy tubing. Conclusion:The results of this study provide insight into a faster, widely available, and cost-efficient alternative to commonly used cystoscopy tubing.

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Timing of Operative Debridement in Open Fractures

Cited by 20 publications

References 49 publications

Time to debridement in open high-grade lower limb fractures and its effect on union and infections: A prospective study in a tropical setting

Time to debridement in open high-grade lower limb fractures and its effect on union and infections: A prospective study in a tropical setting

The evidence base for 2017 BOAST-4 guidance on open fracture management: Are we due an update?

Go with the flow: An experimental analysis with tubing alternative with irrigation

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