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PubMed1994

[Principles for treatment of open fractures].

Fractures with soft-tissue injury are urgent surgical emergencies. Fracture care in the first few hours after the injury crucially determines the course of healing. In open fractures aggressive debridement of all necrotic tissues is mandatory as well as stable external or internal fracture fixation. Secondary wound closure must be performed liberally and prophylactic antibiotics should be administered. Closely observing such a stringent regimen, the rate of posttraumatic osteitis in open fractures can be reduced significantly.

Anti-Bacterial Agents↗
PubMed2000

Bacterial load in tissues and its predictive value for infection in open fractures.

The role of quantitative bacteriology is considered controversial for the prediction of infection in open fractures. A study was done in 20 patients with open fractures. Post debridement pieces of skin, muscle and periosteal tissue were obtained for quantitative bacterial counts. Among a total of 50 samples from all of the tissues, 29 showed positive bacterial counts (16 of 20 skin, 11 of 20 muscle and 2 of 10 periosteum samples). By quantitative estimation, the bacterial load was >10(5) per gram in 10 skin and 3 muscle tissue samples. Infection developed in 9 of the 20 cases within one month, and eight of these patients had contamination of >10(5) per gram in 8 of the skin but only 3 muscle samples. It was concluded that with tissue specific bacterial load estimation, prediction of subsequent infection can be made if skin tissue contains >10(5) per gram, or if muscle tissue carries any level of bacterial presence.

Journal Article↗
PubMed1987

Role of internal fixation in infection of open fractures: studies with Staphylococcus aureus and Proteus mirabilis.

Studies of infections in open fractures are described. The hamster was chosen as the experimental model. Osteotomies of the femur were created with an osteotomy saw. Some osteotomies were left to heal and others were fixed with an 0.9 mm K-wire. The infection rates in fixed and unfixed fractures were compared. The first group of hamsters with fixed and unfixed osteotomies was returned to cages with open wounds. There was no difference in the infection rate at 2 weeks. The second group was deliberately contaminated with Staphylococcus aureus and then returned to cages with open wounds. In this group, the infection rate at 2 weeks was lower in the internally-fixed fractures than in the unfixed fractures. The third group was deliberately contaminated with the gram negative organism Proteus mirabilis. In these animals, the infection rate was increased in the presence of the internal fixation device. The fourth group was deliberately contaminated with both Staphylococcus aureus and Proteus mirabilis. The infection rate in these animals was very high; Proteus was recovered from those animals with internal fixation and Staphylococcus was recovered from those animals without internal fixation. These studies in the hamster document the usefulness of this animal as an inexpensive and reproducible model for studying infection of open fractures. The hamsters tolerated the procedure well, and wound and fracture healing progressed satisfactorily.

Animals↗
PubMedDate not supplied

Open fractures. Long-term results in 200 consecutive cases.

Two hundred consecutive patients admitted with 214 open fractures were reevaluated 6--10 years following injury. All patients were seen in follow-up by the authors. The average hospital stay was 36 days. Many of the patients sustained multiple injuries in automobile accidents. Concomitant head, chest or abdominal trauma occurred in 41% of the patients; 38% sustained multiple fractures. The average patient achieved full weight-bearing at 28 weeks. Late complications were infrequent. All postoperative bone infections (7%) were eradicated with appropriate treatment an average of 27 months postinjury; all of the infected fractures united, and no major limitations of motion resulted. Roentgenograms taken an average of 8 years postinjury revealed only 9 patients with major joint incongruities or arthritic changes. All of the fractures were united except for one with an asymptomatic fibrous union of the patella. Anatomic restitution was possible in most patients. Only one patient had an axial malalignment which necessitated correction by osteotomy and 6 patients had shortening of 1 cm or less. The functional results were excellent with only minor limitations of motion having been found in 25 patients. Disability payments were made to 39 patients and all patients (except for the one who retired due to age) had returned to their prior jobs.

Femoral Fractures↗
PubMed1989

Treatment of open fractures of the tibial shaft: Ender nailing versus external fixation. A randomized, prospective comparison.

A randomized, prospective study comparing Ender nailing with external fixation for open fractures of sixty-three tibiae (sixty patients) was undertaken. Ender nailing proved to be at least as effective as external fixation with respect to seven parameters: time to union, tibial alignment, total number of operations, ranges of motion of the knee and ankle, pain, presence of infection, and complications. Ender nailing is a safe alternative to external fixation for grade-I and grade-II open fractures. It should not be used for comminuted fractures, which might shorten about the nails.

Adolescent↗
PubMed1992

Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming.

Fifty open fractures of the tibial shaft that were treated with débridement and interlocking nailing without reaming were followed for an average of twelve months. Most of the fractures were the result of high-energy trauma, and 68 per cent of the fracture wounds were grade III. Forty-eight (96 per cent) of the fifty fractures united at an average of seven months; there were no malunions. There were four infections (8 per cent), all at the sites of grade-III fractures. Locking screws broke in five tibiae (10 per cent), but the breakage did not result in a loss of reduction. Three nails broke, two at the sites of ununited fractures and one at the site of a healed fracture. These results are comparable with, or better than, those obtained with other forms of fixation, including immobilization with a cast, unlocked intramedullary nailing, and external fixation.

Adolescent↗
PubMed1998

The role of fixation of the fibula in open fractures of the tibial shaft with fractures of the ipsilateral fibula: indications and outcomes.

To determine the indications for fibular fixation in cases of combined fractures of the tibia and fibula and the effect of fibular fixation on tibial healing, a retrospective study of open fractures of the tibial shaft with concomitant fibula fractures was conducted at a level one trauma center. Apparent indications for fibular fixation included the presence of a syndesmotic injury and location of fracture within the distal third of the fibula. No significant differences were found in the healing rates, incidence of nonunion and malalignment, or in the number of required subsequent procedures between patients who did and did not undergo fibular stabilization. These results suggest that fixation of the fibula in open fractures of the tibia and fibula has no effect on fracture healing or alignment. A randomized, prospective study is needed to properly validate these findings.

Fibula↗
PubMed1976

[Open fractures of the hand joints].

In the authors' opinion the optimal treatment of the open fractures of the hand articulations is the internal fixation offering the best fixation possible--this being the best antidote of the inflammatory complications and assuring the satisfactory late functional results. The splinting (stabliizing) methods known so far--as well as the preventive measures applied by the authors against inflammatory complications are discussed.

Fracture Fixation, Internal↗
PubMed1982

Proper timing of amputation for open fractures of the lower extremities.

Judging the appropriate time for amputating lower extremities with open fractures and major soft tissue damage is a major problem for physicians. Limb salvage through vascular repair and external fixation is frequently unjustified. Attempts at saving a limb that should be amputated often are followed by renal failure, sepsis, and death. Much research remains to be done in this area.

Acute Kidney Injury↗
PubMed1983

Pitfalls in the management of open fractures with Hoffmann external fixation.

There have been many improvements made in external fixation, and fixators are being applied with renewed enthusiasm. Inspite of advances in design and application, complications related to the treatment of open fractures are still frequent. Although external fixation has dramatically improved the treatment of open fractures and made possible the salvage of previously amputated limbs, it is a complex technique with many pitfalls. These problems fall into two broad categories: those related to the application and maintenance of the pins and frame on one hand, and those related to the management of soft tissue and bony injuries on the other.

Amputation, Surgical↗
PubMed1985

[Bone formation after graded distraction in patients with open fractures of the long tubular bones complicated by purulent infection].

Osteogenesis under the above conditions is studied on the material of biopsies from 22 men with the open fractures of long bones complicated with a purulent infection. The increasing space between the edges of the fractured bone is filled with an osteoid tissue and subsequently a normal bone tissue is formed. The cells with a high proliferative activity (an intense DNA synthesis) are localised exclusively or predominantly in the wall of the capillary type vessels or in their vicinity. This indicates a close link between angiogenesis and osteogenesis. It is possible that the undifferentiated precursor cell which is the main source of the formation of all components of a new bone is localised in the wall of small vessels as a pericyte or adventitial cell. The method of graded distractional osteosynthesis in combination with the use of a controlled abacterial medium gives a possibility to replace without a free bone transplant big bone defects in open fractures complicated with a purulent infection.

Fractures, Open↗
PubMed1992

Immediate internal fixation of open fractures of the diaphysis of the forearm.

Immediate (within 24 h) open reduction and internal fixation of 103 open fractures of one or both bones of the forearm was accomplished in 69 patients between 1980 and 1989. Fifty-four of the 103 patients were reevaluated 1 to 7 years postinjury (average 2.5 years) to determine the efficacy of this treatment. Forty-five (90%) of the 50 patients with Grade I, II, or IIIA injuries had satisfactory results. The four patients with Grade IIIB or IIIC injuries had unacceptable results. This study demonstrates, as have previous investigations, that immediate open reduction and internal fixation of open forearm fractures provide acceptable results in Grades I, II, and selected Grade III injuries. The subdivision of Grade III fractures into A, B, and C types provides a previously unreported statistically significant difference in the results obtained in management of these injuries. The difference in results in Grade I, II, and IIIA injuries as compared to the Grade IIIB and C injuries was statistically significant (p = 0.0004). The difference in Grade IIIA injuries as compared to Grade IIIB and C injuries was also significant (p = 0.014). Immediate open reduction and internal fixation can be recommended in Grade I, II, and IIIA open forearm fractures. Although it is unclear from this report whether the results in Grade IIIB and C fractures were due to the management protocol, the severity of the initial injury, or combined factors, immediate open reduction and plate fixation yielded poor results in these injuries.

Academic Medical Centers↗
PubMed1981

[Incidence of open fractures in children (author's transl)].

In nine years 8144 cases of fractures in children were treated in Lorenz Böhler Accident Hospital in Vienna. 5.3% of these were fresh open fractures, more than half of which were of the thumb and fingers, with a large proportion of open fingertip fractures. These were followed by, in order of frequency, forearm fractures, skull fractures and tibia fractures. On average, 63% of the patients were boys, the percentage increasing, however, with age. Pre-school children constituted about half as many of the patients as children of school age. Traffic accidents, mainly those involving pedestrian children, caused three times as many open fractures as closed fractures. The figures given are compared with the number of closed fractures.

Accidents↗
PubMed1990

External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. A sequential protocol.

Between 1983 and 1989, forty-one open fractures of the tibial shaft were treated with débridement and provisional external fixation, followed by delayed soft-tissue closure and subsequent intramedullary nailing with reaming. The average duration of external fixation was seventeen days (range, six to fifty-two days). The average time between removal of the fixator and intramedullary nailing was nine days (range, zero to twenty-four days). Of thirty-nine patients who had adequate follow-up, two (5 per cent) subsequently had a deep infection. Both infections healed, with retention of the nail and without chronic osteomyelitis. There were two nonunions and one delayed union. Satisfactory alignment was achieved in thirty-seven patients (95 per cent). This sequential protocol for treatment, which involved a short period of external fixation and thus minimized colonization of the pin tracks, yielded excellent results and a low rate of infection.

Adolescent↗
PubMed1975

[Classification of 557 open fractures of the leg and results of the treatment].

The results of the treatment of 557 open fractures of the leg are discussed from the standpoint of healing of the fractures. According to the severity of the fracture the patients have been ranked into 3 groups. Although in 95,1% of the patients recovery was obtained, in 50% of severe injuries healing occurred only over 20 weeks. The time of recovery was influenced unfavourably by the non stable osteosyntheses. Conservative treatment performed in a great number of patients yielded satisfactory results. The number of the cases treated with stable osteosynthesis is relatively small for comparison with the former groups. In the authors' opinion, the classification of the cases according to the severity of the fracture is of great importance, since it influences the treatment, the recovery time as well as the prognosis.

Adult↗
PubMed1987

Antibiotics in open fractures of the distal phalanx?

A prospective trial was undertaken on 85 adult patients with open fractures of the distal phalanges of less than 6 hours duration, treated by conventional surgery. They either received no antibiotic therapy, or cephradine in short or long courses. The infection rate was 30% in the group without antibiotics and less than 3% in the treated groups. Three different antibiotics regimes were compared, with no difference in the infection rate: therefore the simplest and surest method, a single pre-operative dose and a single post-operative dose, is recommended.

Adult↗
PubMed1999

Immediate autografting of bone in open fractures with bone loss of the hand: a preliminary report. Case reports.

Three patients with open fractures of the hand associated with bone loss were treated within four to six hours of injury by corticocancellous bone grafting and soft tissue coverage after meticulous debridement, copious irrigation of the wounds, and broad-spectrum antibiotics given intravenously. Long term follow-up was uneventful and showed that the graft had taken and healed well with early and full restoration of function and a good cosmetic result. Immediate corticocancellous bone grafting of an injured hand could be used in selected cases with well-debrided, surgically clean wounds as long as there is a rich blood supply. Adequate bone fixation, soft tissue coverage, and broad-spectrum antibiotics given intravenously will remove the risk of infection. Hand architecture is corrected while wound contracture and secondary deformity are avoided. Both patients' discomfort and hospital costs are considerably reduced.

Adult↗