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PubMed2006

Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures.

As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was > or = 3 mm.

Adolescent↗
PubMed1999

[C-reactive protein and transthyretin in early diagnosis of infection after open fractures of the lower limbs (a preliminary study)].

PURPOSE OF THE STUDY: The authors investigated the value of C-reactive protein (CRP) and transthyretin (TTR) in the early diagnosis of infection after open fractures of the lower limb in an open, prospective study. MATERIAL AND METHODS: Eighty patients were treated with acute debridement and bone fixation. Follow-up included clinical, radiological, bacteriological and biological assessment: white cell blood count (WBC), erythrocyte sedimentation rate (ESR), CRP and TTR. Diagnosis of infection was based on macroscopic presence of pus. RESULTS: Post-operative reference biological profiles were defined in 74 cases without infection. Reference profiles of WBC and ESR showed unreliable interindividual variations and could not be considered for the diagnosis of infection. Reference profiles of CRP and TTR showed a respective increase (for CRP) and decrease (for TTR) in the early post-operative course, with return to normal values after 12 days. In 6 infected patients, CRP concentrations were suddenly increased and TTR concentrations decreased at the time (3 cases) or even before (3 cases) clinical diagnosis of infection. These variations were mostly simultaneous. No unusual profile was found. The ratio of CRP/TTR concentrations experienced also a sudden increase in infected cases. DISCUSSION: Because of not specifical and unreliable variations in the post-operative outcome of non infected patients, WBC and ESR cannot be considered for the early diagnosis of infection. CRP and TTR concentrations with a respective cut-off value of 100 mg/L and 120 mg/L were found efficient for the early diagnosis of infection, and preceded clinical diagnosis in three of them. A CRP/TTR ratio over 60 p. 100, 8 days or more after initial surgery was found to be very specific (93 p. 100) and sensitive (100 p. 100) for the diagnosis of infection. CONCLUSION: Serial quantifications of CRP and TTR should be performed every four days during the follow-up of open fractures in order to early diagnose a post-operative infection. Comparison of both CRP and TTR could allow a higher accuracy, because of the possible lack of variation of one the two markers.

Adolescent↗
PubMed1983

[Open fractures of the fingers in children].

The experience with the treatment of open fractures of finger phalanges in 187 children is presented. The operation technique and curative methods are described for patients with soft tissue defects.

Child↗
PubMed1978

Treatment of open fractures: a review.

The history, etiology, initial management, and definitive treatment of open fractures is comprehensively reviewed. The author explores with particular care the crucial problem of preventing infection.

Anti-Bacterial Agents↗
PubMed1980

[Treatment of open fractures of tubular bones].

The results of treatment of 158 patients with open fractures of bones were analyzed. They depended on different factors: time of admission of the patient, the degree of the injury (according to Kaplan--Markova), choice of the radical surgical treatment of the wound, rational application of antibiotics, intraosseous perfusion, enzymotherapy etc. Treatment of the wound after Syzganov--Tkachenko has been shown to be very effective.

Adolescent↗
PubMed1987

Management of open fractures with sterilization of large, contaminated, extruded cortical fragments.

The literature provides surprisingly little guidance for the management of Grade III open fractures with large extruded segments of long bones. A 10-cm segment of femoral diaphysis was reimplanted successfully in a 24-year-old man with a comminuted segmental open fracture. For basic information, laboratory studies were performed to determine the relative efficacies of various methods of sterilization of contaminated bovine metatarsals. Bovine bone segments were given one of the following treatments: (1) saline rinse; (2) povidone-iodine scrub/saline rinse; (3) povidone-iodine scrub/autoclaving; (4) povidone-iodine scrub/thimerosal immersion; (5) povidone-iodine scrub/povidone-iodine immersion; or (6) chlorhexidine gluconate scrub antibiotic solution immersion. The segments were then cultured. Only the povidone-iodine/autoclave and chlorhexidine gluconate/orthopedic antibiotic solution treatments were 100% effective in eliminating bacterial growth. Contaminated extruded segments of long bones can be adequately sterilized for reimplantation by surgical cleansing with chlorhexidine gluconate followed by brief soaking in antibiotic solution.

Adult↗
PubMed2005

Host classification predicts infection after open fracture.

UNLABELLED: We propose that the classification commonly used in patients with osteomyelitis, the Gustilo classification, also is applicable to patients with open fractures as a method of identifying increased risk of infection because of comorbid medical illness. The records of 174 adult patients sustaining open fractures of long bones were retrospectively reviewed. Each patient was sorted into Class A, B, or C based on 14 immune system compromising factors. Class A has no compromising factors, Class B has one or two compromising factors, and Class C has more than three compromising factors. The association between class and infection was examined. The incidence of infection was 4%, 15%, and 30% in patients in Classes A, B, and C, respectively. Patients in Class B were 2.86 times more likely to have an infection, and patients in Class C were 5.72 times more likely to have an infection when both groups of patients were compared with patients in Class A. The Gustilo classification, location of fracture, and tobacco use are all factors associated with infection. Patients in Class B or C are at markedly increased risk of infection and may benefit from additional or alternative therapies that decrease the risk of infection. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed1989

The use of P.O.P. integrated transfixation pins as an improvisation on the Hoffmann's apparatus: contribution to open fracture management in the tropics.

With consideration to the relatively high complication rate of internal fixation methods in the management of open fractures, 16-36% (17), the use of 'fixateur externe' or Hoffmann's apparatus is widely accepted as the best method of management. We do not have this valuable apparatus in our hospital due to the socioeconomic constraints typical of developing countries. We found a valuable improvisation in the use of Bohler's transfixation methods and even to the extent of achieving osteotaxis and ambulation. The management method is described with our positive experiences of its use in 28 cases of open fractures and other bone and joint afflictions. The advantages and disadvantages of the method are discussed. The method is recommended as a valuable substitute for the 'fixateur externe.'

Adolescent↗
PubMed1994

The role of early flap coverage in the management of open fractures of both bones of the leg.

Sixty patients with type III injuries (open fractures) of the tibia were treated in a prospective fashion by combined orthopaedic and plastic surgical schemes based on the principles of early radical cleaning, a second-look operation, and early coverage of soft tissue defects with an appropriate local or distant flap. Stabilization of fractures was achieved by external fixation in most cases and patients were allowed to walk within 4-8 weeks (partial weight bearing). Bony union was achieved in 23.4 weeks. The mean hospital stay was 3.5 weeks. Limb salvage was achieved in all cases and there were no major complications.

Adolescent↗
PubMed2004

Delays in open fracture management: where do they occur?

We audited the delays in the management of 29 patients presenting to our department with 30 open fractures over a 1-year-period to ascertain where the most lengthy delays were occurring. Gold standard treatment is the surgical debridement and stabilisation of the fracture within 6h of injury. In our series only 14 patients achieved this standard. The lengthiest delays were in getting a patient to the operating theatre following orthopaedic assessment. We have introduced an "open fracture proforma" to highlight the time-critical nature of the injury in an effort to speed-up the process.

Debridement↗
PubMed1976

[Conservative and surgical treatment of open fractures of the forearm].

On the basis of the 10 years' material of the Hugarian National Institute of Traumatology the possibilities of treatment of the open fractures of the forearm are discussed. It is stated by the authors that operative treatment of the open fractures of the forearm is more and more frequent, and--chiefly in the last time--the surgeon strives to obtain rigid internal fixation. If the individual and objective conditions of the internal fixation are not given or the operation seems risky for other reasons--intramedullary splinting--completing the conservative treatment--or wire fixation are the method of choice. In connection with fractures of different type the authors' method is discussed and a few cases are reported.

Bone Nails↗
PubMed1996

Effective management of osteomyelitis after grade III open fractures.

We report results and follow-up on a series of 34 patients who had chronic osteomyelitis resulting from complex open fractures. Treatment included debridement followed by cancellous bone grafting and simultaneous free flap transfer for coverage and revascularization. Thirty-one patients remained in the final study. For the 24 patients with lower extremity injuries, follow-up averaged 45.4 months (range, 10 to 84 months). There was a 4% recurrence rate of osteomyelitis (1 of 24 patients). Follow-up on the 7 patients with upper extremity injuries averaged 39.8 months (range, 22 to 60 months). There were no recurrences in this group. Serial debridement followed by simultaneous bone grafting and free flap transfer may be the most effective method available for the treatment of chronic osteomyelitis after grade III open fractures. This method produces the same results currently reported in the literature, but with one less operation.

Adolescent↗
PubMed1998

Update on the management of open fractures of the tibial shaft.

A retrospective study of 133 open tibial fractures in 129 patients treated at the Hennepin County Medical Center between 1986 and 1993 was done. The results of the treatment protocol in this patient group is presented and the current classification schemes, prevention of infection, debridement, antibiotics, soft tissue reconstruction, fracture stabilization methods, bone grafting, and exchange nailing are discussed. Recent studies that have documented interobserver disagreement in the classification of open fractures underscore the difficulties encountered in the initial assessment and treatment of open tibial shaft fractures. Despite repetitive and aggressive debridement, a certain number of fractures will remain contaminated and become infected. Infection after these severe injuries is probably multifactorial, and its prevention requires that the surgeon diligently adhere to the imperatives of open fracture care.

Anti-Bacterial Agents↗
PubMedDate not supplied

Diversity of coryneforms found in infections following prosthetic joint insertion and open fractures.

In a 5-year period, 73 coryneform isolates from prosthetic joint and open fracture infections in 60 patients treated in a hospital specialized in orthopedic surgery were speciated. The most frequent species were Corynebacterium amycolatum, Corynebacterium striatum, Corynebacterium diphtheriae biotype mitis, and Corynebacterium jeikeium. At least 14 isolates were deemed clinically significant as sole agents of infection.

Actinomycetales↗
PubMed2004

Local antibiotic therapy in the treatment of open fractures and osteomyelitis.

Local antibiotic therapy is part of the treatment protocol of open fractures and osteomyelitis. However, there are limitations in the literature evaluating the efficacy of the technique and controversies remain. Polymethylmethacrylate cement commonly is used as a delivery vehicle, but bioabsorbable vehicles are being investigated. The vehicle is impregnated with antibiotic(s) active against the suspected pathogens, usually an aminoglycoside and/or vancomycin. Elution depends on the surface area, the characteristics and permeability of the delivery vehicle, type and concentration of the antibiotic(s) used, presence of fluid, rate of fluid turnover, and time postimplantation. Local antibiotic therapy is a safe technique resulting in high local concentration of antibiotics with minimal systemic levels. Local antibiotics effectively have controlled infection in animal models and, despite limitations of the existing literature, seem to be useful in the clinical setting. The length of implantation and the need for removal of the delivery vehicle remain controversial. Nonabsorbable vehicles may eliminate the need for reoperation and removal.

Animals↗
PubMed1990

[Treatment of open fractures and dislocations of hand long bones].

Efficiency of different fixation methods of open fractures and dislocations of hand tubular bones on the basis of treatment experience of 206 patients has been investigated in clinical conditions. Immobilization with a plaster bandage, osteosynthesis and transarticulation fixation by wires, osteosynthesis by external fixation apparatus were used. An analysis of long-term results of treatment of 128 patients demonstrated that fixation of damaged bones and joints by the external fixation apparatus is the most effective one.

External Fixators↗
PubMed1990

[Atypical osteogenesis following multiple sequestrectomies for infected open fracture of the femur: a case].

The authors present the case of an open fracture of femur Cauchoix type II with an infection due to Escherichia coli, Clostridium perfringens, Enterococcus and Aspergillus fumigatus. After several sequestrectomies and five hyperbaric sessions, apyrexia was attained at the end of the third month, the femur having been stabilised with an external fixator. The 15 cm gap due to loss of bone substance, filled at each dressing with an antiseptic iodine based ointment, closed itself finishing as continuous bone five months after the accident, the granulation tissue having been recovered by thin skin grafts. A repeated fracture occurring forty-eight hours after the removal of the Hoffmann frame was treated by fitting an Ilizarov fixator arriving at consolidation in seven months. The authors examine different possibilities of accelerating osteogenesis and highlight the potential role of iodine ointment as inductive to osteogenesis stemming from a periosteal layer seemingly held in place.

Adult↗
PubMed1987

External fixation for skeletal stabilization of severe open fractures of the hand.

The successful use of external fixation to stabilize severe open fractures elsewhere in the body has led to its adaptation in the hand. It is particularly useful when extensive wounds prohibit internal fixation and when comminution and bone loss render the fracture difficult to control by other methods. External fixation permits simultaneous wound access and fracture management. It can be used alone or adjunctively with other methods of fixation such as Kirschner wires, screws, or plates for definitive fracture management. Alternatively, external fixation can be used for provisional fracture management until wound conditions permit the application of other means of osteosynthesis.

Adolescent↗