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At least 307 records · Page 17Linked to original sources
PubMed1990

Role of antibiotics in open fractures of the finger.

The role of antibiotics was investigated prospectively in 91 open fractures of the finger. Antibiotics were administered to alternate patients with open phalangeal fractures. Only finger fractures distal to the metacarpophalangeal joint were included. Both groups were treated with aggressive surgical irrigation and debridement. In four patients in each group clinical signs of infection eventually developed; osteomyelitis did not develop in any patients, and no secondary surgical procedures were required in either group. This data indicates that vigorous irrigation and debridement is adequate primary treatment for open phalangeal fractures in fingers with intact digital arteries.

Adolescent↗
PubMed1989

Microbiologic flora contaminating open fractures: its significance in the choice of primary antibiotic agents and the likelihood of deep wound infection.

A clear understanding of the significance of wound contamination as well as knowledge of the microbial flora that could be expected are needed in order to administer a rational and effective antibiotic treatment for open fractures. We have conducted a prospective study of the contaminating microbial flora in 89 open fractures. In addition, two more cultures were taken of all wounds not primarily closed. Wound and fracture healing were followed in all patients. Most fractures were Gustilo grade II (58.4%) caused by work-related accidents. Wound cultures were positive in 83% of all fractures, and a total of 84 strains of bacteria were isolated. In 39.3% of cultures, various species of aerobic Gram-negative rods (most commonly Pseudomaonas aeruginosa) were retrieved, followed by Staphylococcus epidermidis (34.5%) and Staphylococcus aureus (26.1%). Repeat cultures were mostly either negative (59.5%) or grew saprophytic organisms that were usually nonpathogenic (such as various species of saprophytic Bacillus bacteria). The only cases that developed deep wound infection were those where a repeat culture 1 day after debridement grew the same organisms as the initial organisms. We conclude that (a) most open fractures are already contaminated upon the patient's arrival at the emergency department, in many cases by potentially pathogenic staphylococci and Gram-negative organisms; (b) contaminating organisms are community acquired and, as such, are sensitive to most routine antibiotics; and (c) persistence of the same organisms in a repeat culture taken 1 day after debridement signifies technical failure of debridement and a subsequent very high risk of infection. Therefore, achieving adequate wound asepsis immediately following debridement is of the utmost importance.

Adult↗
PubMed1983

Open fractures of the tibia treated with the Lottes nail.

Of fifty consecutive open fractures of the mid-part of the shaft of the tibia that were treated from 1975 to 1980 with immediate intramedullary Lottes-nail fixation and with débridement and irrigation, with minimum periosteal disruption, all but one healed. The rate of infection was 6 per cent; of delayed union, 16 per cent; and of malunion, 4 per cent. One fracture, with arterial injury, resulted in amputation. The wounds were classified as Gustilo and Anderson Type I (24 per cent), II (12 per cent), or III (64 per cent). Seventy-six per cent of the patients had other fractures, and 38 per cent had a fracture of the ipsilateral femur. Sixty-four per cent of the fractures were segmental and 36 per cent were transverse with comminution.

Adolescent↗
PubMed1979

Primary excision and grafting of burns located over an open fracture.

Early excision of the burn, immediate autografting, reduction of the fracture, and stabilization with a plaster-of-paris cast is offered as an alternative method for managing burns with associated long-bone fractures. The opportunity to excise and immediately autograft a burn wound requires rethinking of the entire problem of burns associated with a fracture.

Adolescent↗