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At least 19 recordsLinked to original sources
PubMed1991

Choice and duration of antibiotics in open fractures.

Open fracture wounds are contaminated wounds, and wide spectrum antibiotic therapy effective against both gram-positive and gram-negative organisms is recommended. Combination therapy has been shown to be effective in significantly reducing the infection rate in open fractures. For type I and II open fracture wounds, 3 days of antimicrobial therapy is recommended; for type III open fracture wounds, 5 days of treatment is recommended. When secondary procedures are performed, such as bone grafting, open reduction and internal fixation, soft tissue transfers, and other procedures involving the fracture site, an additional 72 hours of therapy is recommended. When antibiotic therapy is given after the initial period, antimicrobials administered should be selected on the basis of the culture and sensitivities of the original infecting organisms.

Administration, Topical↗
PubMed1980

Immediate internal fixation in open fractures.

Open fractures require emergency treatment. Adequate debridement and copious irrigation are essential in their management. The parenteral administration of antibiotics should be started immediately. If the wound is closed primarily, the antibiotics are discontinued after three days. If the wound is closed secondarily, the antibiotics are continued for another three days after this procedure. Most open fractures should be treated without the use of internal fixation techniques. However, we believe that there are reasons for employing immediate internal fixation, particularly in polytraumatized patients and others sustaining type III open fractures, to facilitate care of the soft tissue. When immediate internal fixation techniques are used in open fractures, the wound must not be closed primarily.

Adult↗
PubMed2005

Management of open fractures.

Open fractures are high-energy injuries that require a principle-based approach, starting with detailed evaluation of patient status and injury severity. Early, systemic, wide-spectrum antibiotic therapy should cover gram-positive and gram-negative organisms, and a common regimen is a 3-day administration of a first-generation cephalosporin and an aminoglycoside, supplemented with ampicillin or penicillin to cover anaerobes in farm or vascular injuries. Local antibiotic delivery with the bead pouch technique increases the local concentration of antibiotics, minimizes systemic toxicity, and prevents secondary wound contamination. Thorough irrigation and surgical debridement is critical for prevention of infection. Primary wound closure remains controversial because of concerns for gas gangrene. Partial wound closure is an alternative, with delayed wound closure within 3 to 7 days. In the presence of extensive soft tissue damage, local or free muscle flaps should be transferred to achieve coverage. Stable fracture fixation should be achieved with a method suitable for the bone and soft tissue characteristics. Early bone grafting is indicated for bone defects, unstable fractures treated with external fixation, and delayed union. A management plan guided by the above principles will achieve the goals of prevention of infection, fracture healing, and restoration of function in most of these challenging injuries.

Adult↗
PubMed1993

[Indications and incidence of spongiosa transplantation in open fractures: analysis of 470 open fractures].

From a prospective series of 651 open fractures, treated at the institution of the authors in the years 1984-1989, 124 cancellous bone grafts in 470 open long bone fractures--651 open fractures excluding amputation after Type III open fractures, excluding traumatic amputations and open fractures of the ankle joint and foot--were analyzed using approximately 155 variables per individual fracture to deduct the influencing factors for indication and frequency of bone grafts. As a result of this analysis it could be shown that bone grafting depends significantly on variables describing the bone injury as well as the type of fixation used. The frequency of bone grafts in this series was much higher than stated in the literature. The time of surgery for bone grafting depends on the type of fixation used, the concomitant soft tissue injury and the amount of primary bone loss. In contrast to the literature the analysis revealed that for good indications the use of allogeneous bone grafts in open fractures is possible.

Adult↗
PubMed1993

[Incidence of pseudarthroses in open fractures: analysis of 948 open fractures].

In a retrospective and prospective analysis of 948 open fractures, treated at the institution of the authors in the years from 1981 to 1989, approximately 155 variables were used to deduce factors influencing the development of posttraumatic non-unions. This analysis reveals that only variables describing the bone injury show a statistical significant influence on posttraumatic non-union. Consideration of the results of the retrospective analysis in the management protocol of open fractures led to a significant decrease of non-union rates in the prospective series of 651 open fractures. An unchanged statistical influence in the development of non-unions could be found for factors representing the bone damage of the underlying injury. Variables describing the soft-tissue injury show a linear regression with the duration of bone healing time. Using the Hannover Fracture Scale is an appropriate tool for treatment control and risk prediction concerning post-traumatic non-unions.

Cross-Sectional Studies↗
PubMed1993

The incidence of osteitis in open fractures: an analysis of 948 open fractures (a review of the Hannover experience).

Even though treatment protocols of open fractures have been improved in the past two decades, osteitis is still a major complication in these injuries. To investigate the primary factors responsible for posttraumatic osteitis, 19 cases of osteitis out of 297 open fractures (retrospective series from 1981 to 1983) and nine cases of osteitis out of 651 open fractures (prospective series from 1984 to 1989) were analyzed. The Hannover fracture scale was used for quantitative evaluation of the injury. A high prognostic index for bone infections was found for the amount of bone loss, the fracture type, the type of bacteriologic contamination, deep soft-tissue defects, compartment syndromes, vascular injuries, and soft-tissue infections.

Fractures, Open↗
PubMed1984

Problems in the management of type III (severe) open fractures: a new classification of type III open fractures.

Between 1976-1979, 87 Type III open fractures (in 75 patients) were treated at the Hennepin County Medical Center. Factors leading to increased morbidity in Type III fractures were: massive soft-tissue damage; compromised vascularity; severe wound contamination; and marked fracture instability. This study demonstrates, because of varied severity and prognosis, that the current designation of Type III open fracture is too inclusive. We recommend, therefore, that Type III open fractures be divided, in order of worsening prognosis, into three subtypes. Type IIIA--Adequate soft-tissue coverage of a fractured bone despite extensive soft-tissue laceration or flaps, or high-energy trauma irrespective of the size of the wound. Type IIIB--Extensive soft-tissue injury loss with periosteal stripping and bone exposure. This is usually associated with massive contamination. Type IIIC--Open fracture associated with arterial injury requiring repair. Wound sepsis in the three subtypes were: Type IIIA, 4%, IIIB, 52%; and IIIC, 42%; while amputation rates were, respectively, 0%, 16%, and 42%. Only two patients developed osteomyelitis, and 12 patients had delayed or nonunions. Five patients died, all as a result of multisystem trauma. The bacterial pathogens in infected open fractures have changed dramatically over the years. In the present series (1976-1979), 77% of infections were due to Gram-negative bacteria, compared with 24% previously (1961-1975). A change of antibiotic therapy from a first-generation cephalosporin alone to a combination of a cephalosporin and an aminoglycoside, or a third-generation cephalosporin, is currently indicated in Type III open fractures.

Adolescent↗
PubMed1995

Open fracture management.

Open fractures are complicated cases requiring methodical evaluation for the optimal outcome. The initial handling of the case can play a major role in the outcome of the fracture. Management of the pet with an open fracture from the time or presentation through the postoperative period has been presented. Prognosis and some complications associated with open fractures were outlined and treatment options for some of the complications were provided.

Animals↗
PubMed1992

Management of open fractures.

An open fracture is an orthopaedic emergency that can lead to devastating complications and prolonged rehabilitation. The goals of treatment are to prevent infection, achieve bone union, and restore function. The treatment should involve the use of antibiotics, repeated thorough irrigation and debridement, early fracture stabilization, early wound closure, and aggressive rehabilitation. The result of treatment is largely affected by the initial soft-tissue loss, wound contamination, fracture stability, and neurovascular status.

Amputation, Surgical↗
PubMed2006

Open fractures and infection.

Open fractures still represent a major challenge for the treating surgeon and frequently demand a complex of soft tissue and bone procedures to achieve an undisturbed healing with adequate limb function. However, despite improvement in operative techniques and antibiotic therapy septic complications still occur in severe open fracture forms up to 50%. They are still deleterious for the patient as well as a major economic factor for the treating hospital. Radical (repetitive) debridement of the wound and coverage of soft tissue defects are of utmost importance in the prophylaxis of septic complications along with antibiotic therapy. If the local wound requires flap coverage, early performed procedures yield a clear decrease of infection rates even in most severe fracture forms. Osseous stabilization contributes to infection prophylaxis, especially when the implants can be inserted in a minimal invasive way and provide an adequate handling of soft tissues and the wound. Thus, most often intramedullary nails and external fixators are used today for osteosynthesis. Recently developed plates with angular stability offer a promising alternative even in open fractures, especially when there is an extension of the fracture into the meaphyseal area though indications have to be evaluated. Manifest septic complications demand an early and aggressive approach with radical eradication of the septic topic. While acute infections require most often only minor surgical procedures and offer the chance to leave implants in situ, chronic infections usually demand complex reconstructive measures of bones and soft tissues.

Debridement↗
PubMed1986

The role of intramedullary fixation in open fractures.

Intramedullary nailing of open fractures requires careful surgical judgment, consideration of alternative techniques, and the ability to use a number of different methods, including various designs with or without obligatory reaming. With good technique and well-selected indications, intramedullary nailing of open fractures may offer advantages not available through other types of fracture stabilization. Open fractures of the femur are best treated with delayed closed reamed nailing. Acute open nailing of the femur is justified to salvage life and limb in multiply injured patients. Acute nonreamed nailing of open fractures of the tibia has been shown to give results comparable to external skeletal fixation. The role for intramedullary nailing of open fractures of the upper extremity is limited.

Bone Nails↗
PubMedDate not supplied

Timing of closure of open fractures.

Traditionally, closure of open fractures after initial debridement has been delayed to minimize the risk of complications, particularly infection. This practice developed before the widespread use of systemic antibiotics, local antibiotic bead pouches, advanced debridement methods, and improved fracture stabilization techniques. Current evidence indicates that infections after treatment of open fractures frequently are not caused by initial contaminating organisms but often are acquired in the hospital. Recent studies comparing primary with delayed closure have not demonstrated an increased rate of complications. Considering the improvements in open fracture wound care, the increasing incidence of resistant nosocomial infections, and the cost implications of a dogmatic delayed-closure strategy, wound care protocols for open fractures should be reevaluated. Because of lack of data specifically addressing the timing of closure of such wounds, studies comparing primary versus delayed closure are needed.

Anti-Bacterial Agents↗
PubMedDate not supplied

Open fractures: evaluation and management.

Open fractures are complex injuries that involve both the bone and surrounding soft tissues. Management goals are prevention of infection, union of the fracture, and restoration of function. Achievement of these goals requires a careful approach based on detailed assessment of the patient and injury. The classification of open fractures is based on type of fracture, associated soft-tissue injury, and bacterial contamination present. Tetanus prophylaxis and intravenous antibiotics should be administered immediately. Local antibiotic administration is a useful adjunct. The open fracture wound should be thoroughly irrigated and debrided, although the optimal method of irrigation remains uncertain. Controversy also exists regarding the optimal timing and technique of wound closure. Extensive soft-tissue damage may necessitate the use of local or free muscle flaps. Techniques of fracture stabilization depend on the anatomic location of the fracture and characteristics of the injury.

Fractures, Open↗
PubMed2006

Operative treatment of III grade open fractures of the tibial diaphysis.

UNLABELLED: Open fractures, especially III grade open fractures of the tibial diaphysis, according to the Gustilo classification still remains a serious therapeutic problem. The aim of the study was to evaluate the clinical results after operative treatment of III grade open fractures of diaphysis of the tibia and to promote a new method of fracture fixation. MATERIAL AND METHODS: 48 patients with open fractures of the tibial diaphysis, classified as type III A and B, according to the Gustilo classification, were operatively treated. Patients were divided into two groups depending on the manner of fracture fixation. Patients in group A (30 pts.) were treated with an external fixator and those in group B (18 pts.) with unreamed intramedullary nails. The time of the union of the fracture, problems with the union (malunion and nonunion), infection, different complications and the functional outcome were examined. Late complications and their treatment were not the object of the study. The follow-up period was at least 12 months. The results of the study showed a mean time of union of 38.4 weeks in patients in group A, and 32.8 for those in group B. Malunion was noticed in 5 (16.6%) in group A and 2 (11.1%) in group B, nonunion in 4 (13.35) in group A and in 2 (11.1%) patients in group B. Superficial infection developed in 7 (23.3%) and deep in 6 (20%) of the patients in group A and in group B in 4 (22.2%) and 2 (11.1%) of the patients. Results from the functional examination showed 26.6% excellent and the same percent of fair results in group A. In group B there were 55.5% excellent and 11.1% fair results. Different types of complications were noticed in the patients from both groups. The final results of the examination showed a shorter time of union, a lower percentage of complications and a better functional outcome in the patients in group B. Unreamed intramedullary interlocking nailing of open fractures of the diaphysis of the tibia (grade III A and B according Gustilo classification) is a relatively safe method of operative treatment with fewer complications compared with external fixation.

Adult↗