- See:
open tibia fractures,
open fractures of femur
- Discussion:
- treat all open fractures as an emergency;
- perform thorough initial eval to dx other life-threatening injuries: (see
trauma management);
-
open joint injuries
-
gun shot wounds:
-
controversies: non operative tratment:
-
Nonoperative Management of Pediatric Grade 1 Open Fractures With Less Than a 24-Hour Admission
- Sequential Management:
-
antibiotics:
- therapeutic doses of
ancef and
tobramycin for 48 hrs are appropriate;
- w/ contamination consider anaerobic antibiotics (
penicillins,
clindamycin,
flaggyl);
-
tetanus prophylaxis if appropriate;
- references:
-
Once daily high-dose gentamicin to prevent infection in open fractures of the tibial shaft: a preliminary investigation.
-
Once daily, high dose versus divided, low dose gentamicin for open fractures.
-
Prospective, randomized, double-blind study comparing single-agent antibiotic therapy, cipro, to combination antibiotic therapy in open fracture wounds.
-
Ciprofloxacin Inhibition of Experimental Fracture-Healing.
-
Clostridial myonecrosis.
-
The use of antibiotics in open fractures.
-
Duration of preventive antibiotic administration for open extremity frx;
-
debridement and irrigation:
-
bacterial cultures:
- initial bacterial cultures are probably not helpful;
- references:
-
Efficacy of primary wound cultures in long bone open extremity fractures: are they of any value?
-
Epidemiology of bacterial infection during management of open leg fractures.
-
Efficacy of cultures in the management of open fractures.
-
The significance of perioperative cultures in open pediatric lower-extremity fractures.
-
debridement of open tibial fractures:
-
skin preparation:
-
topical antimicrobials:
-
pressure irrigation;
- immediately debride the wound using copious irrigation (9 lit) and, for
type-II and
type-III fractures, repeat the debridement in 24 to 72 hours;
- note that wounds contaminated by dirt (vs grease, asphault ect) need aggressive repeated debridement inorder to avoid
infection and subsequent
osteomyeltis);
- references:
-
Comparison of isotonic saline, distilled water and boiled water in irrigation of open fractures.
-
The use of bacitracin irrigation to prevent infection in postoperative skeletal wounds. An experimental study.
-
Efficacy of cultures in the management of open fractures.
-
The Effect of Surgical Delay on Acute Infection Following 554 Open Fractures in Children.
-
Comparison of Soap and Antibiotic Solutions for Irrigation of Lower-Limb Open Fracture Wounds.
-
Outcomes in open tibia fractures: relationship between delay in treatment and infection.
-
A review of open tibia fractures in children.
-
The use of detergent irrigation for musculoskeletal wounds.
-
Treatment of isolated type I open fractures: is emergent operative debridement necessary?
-
The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone frx: A 9-yr prospective study from a district general hospital.
-
fracture stabilization:
-
synthes product menu
-
open tibia fractures
-
open fractures of femur
- references:
- The role of early internal fixation in the management of open fractures. Chapman COOR: 138: 120-131, 1979;
-
Immediate internal fixation of open fractures of the diaphysis of the forearm.
-
The influence of skeletal implants on incidence of infection. Experiments in a canine model.
-
Nonoperative management of pediatric type I open fractures.
-
timing of wound closure:
-
wound closure of open tibial fractures
-
soft tissue coverage:
-
general wound management:
-
contaminated wound care:
-
drains and closure of wounds
-
wound dressings and
wound vac:
- in most cases, a delayed primary closure is performed for open wounds, but surgical incisions made during the case can be closed primarily;
- issues involve complete removal of foreign debris as well as need to reassess devitalized muscle;
-
antibiotic bead pouch or
wound vac are useful methods of covering the wound;
- second look debridement can be performed at 48 hours w/ wound closure;
-
bone grafting:
-
management of tibial defects and
bone grafting for open tibia fracture
- it is controversial as to whether bone grafting should be performed in open fractures;
- in the study by Chapman et al (JBJS 1997) 31% of open fractures were treated w/ bone graft substitutes and 28% of open fractures were
treated w/ autogenous bone grafts;
- in this same study, infection at the fracture site occured in 5% of patients in which bone graft substitutes were used versus 13% of fractures in
which autogenous grafts were used;
- references:
Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases.
Review: Treatment of Compound Fractures.
The early management of open joint injuries. A prospective study of one hundred and forty patients.
The use of quantitative bacterial counts in open fractures.
Year Book: Risk of Infection After Open Fracture of the Arm or Leg.
Prevention of Infection in the Treatment of 1,025 open fractures of long bones. Gustilo RB, Anderson JT. JBJS 58-A: p 453-458, 1976. .
The early management of open joint injuries. A prospective study of one hundred and forty patients.
Lead arthropathy: arthritis caused by retained intra-articular bullets.
Duration of preventive antibiotic administration for open extremity frx;
