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At least 163 records · Page 9Linked to original sources
PubMed2004

Disability can be avoided after open fractures in Africa-results from Malawi.

UNLABELLED: In a free-at source hospital in Malawi, East Africa, 55 open fractures were treated within a 3-year period. The majority (33/55) involved fractures of the lower leg. The treatment regimen contained the following: primary external fixation; scheduled sequential debridement; immediate coverage of any bone devoid of periosteum using local muscle or fasciocutaneous flaps, alternatively limb shortening; no skin closure; controlled secondary healing under moist dressings; dynamisation and/or removal of the external fixator followed by functional treatment (Sarmiento and Latta) as soon as the soft tissues permitted. The first 34 consecutive cases were monitored from the time of treatment; 24 of them attended for clinical review at 36 (+/-16) weeks after injury. Only 72% (13/22) patients had reached the hospital within 24h after sustaining the fracture; 80% (18/22) had developed a septic wound infection, which healed in all cases after 20 weeks. At the time of follow-up, recovery of function was found in 20 (80%) of the injured extremities. Only three patients (12%) remained disabled due to the open fracture, one other patient died during treatment from tuberculosis secondary to AIDS and one patient required knee disarticulation. CONCLUSION: If the biological principles guiding the contemporary treatment of open fractures in the first world are respected, results under third world conditions do not differ as much as the differences in setting might suggest. The application of recent advances of global knowledge in trauma surgery into methods of treatment appropriate to the health care systems of highly resource constraint countries remains a rewarding task for modern trauma surgeons and their scientific community.

Developing Countries↗
PubMed1992

[Prognosis and complications of open fractures].

This paper reviews records of Liestal Country hospital, AO Catalogue files and National Swiss Insurance Industry actuarials regarding open fractures. Specific regards are tended toward prognosis forecasting, complications and outcome assessments with respect to industrial "down time" resulting from bone infections and/or pseudarthroses. Evaluation of injuries is contingent upon the Gustilo Classification (1987) which bases prognosis on soft tissue preservation in open fracture injuries. We adhere to well accepted protocols which provide for adequate local primary débridement and stabilization of structural osseous components by means of appropriate fracture fixation. In addition, we have implemented protocols for the preservation of bony vascular elements along with sequential provisions for cancellous bone and soft tissue grafting. Outcome assessments on the range of cases reviewed confirm a traditional perspective that open fractures demonstrate considerably greater morbidity than closed fractures. However, by comparison with previous studies, the results of this series show positive progress toward optimal wound healing. While this more aggressive approach tends initially to be quite expensive, we believe initial costs to the carrier are justified by improved outcome, prognosis and industrial down time.

Adolescent↗
PubMed1981

Open fractures of the tibia.

The authors call attention to the work of Trueta on open fractures and to the fact that, even today, his principles are followed all over the world. Today, such fractures are immobilized with external skeletal fixation instead of plaster casts. The results are presented of 71 patients with severe open fractures of the tibia who were treated by external skeletal fixation. In three patients, in whom infection developed, the fractures united after cancellous bone grafting. Reference is made to some recent experiments on the fat of bone cells transplanted into infected cavities.

Accidents, Traffic↗
PubMed2002

[The treatment outcomes of children with Gustilo-Anderson grade II and grade III open fractures of the long bone].

BACKGROUND: We evaluated the treatment results in thirty-two children who had grade 2 and 3 open fractures according to classification of Gustilo-Anderson. METHODS: There were 21 (%65) male and 11 female (%35) patient and the mean age was 9 years (range, 4-14 years). There were 18 (%56) grade-2, 7 (%22) grade-3A, 5 (%15) grade-3B, and 2 (%6) grade-3C open fracture. All fractures were irrigated and debrided, and then fixed with external fixators. The average duration of follow-up was 11 months (range, 6-28 month). RESULTS: All fractures healed. Inadequate recovering was detected in four patients who had nerve injury, in addition the joint limiting contracture occurred on six patients. CONCLUSION: Fracture union without segmental bone loss is not a significant problem in open fractures in children, and that joint contractures, compartment syndrome and nerve injuries negatively affect the late outcomes.

Adolescent↗
PubMed1996

[Treatment concept and results of grade 3 open fractures with arterial injuries requiring reconstruction].

Ninety-one open fractures associated with arterial injury requiring vascular repair (type IIIC injuries) were treated at the University of Louisville between May 1983 and January 1994. Involved anatomical areas were the humerus (6x), the forearm (11x), the femur (16x), the tibia (36x), the ankle (11x) and the foot (11x). Fracture management consisted of meticulous radical debridement, copious wound irrigation, fasciotomy and fracture stabilization. Additionally, 49 wounds (53.8%) were treated with the supplemental local use of antibiotics (tobramycin-PMMA-beads). Thirty-four patients underwent primary amputation whereas 57 repairs of the injured vessels were performed. There were 7 secondary amputations due to infection or poor revascularization resulting in an overall amputation rate of 45.1%. The wound infection rate was 12.1% (11/91) and the rate for osteomyelitis was 3.3% (3/91). The local use of the antibiotic beads was of significant benefit to lower infectious complications. Primary coverage of the soft tissue defect with free tissue transfer was associated with a high infection rate (2/3) and is not recommended for this type of injury. Temporary wound coverage with the "antibiotic bead pouch" technique until wound closure can be obtained in a sterile and viable environment leads to more satisfying results.

Adolescent↗
PubMed2003

[Treatment of open fracture by vacuum sealing technique and internal fixation].

OBJECTIVE: To investigate the effect of vacuum sealing(VS) technique and emergency internal fixation on the management of limbs open fracture and soft tissue dirty defects. METHODS: Fourteen patients (18 limbs) with open fracture and soft tissue dirty defects were treated by the VS technique and internal fixation after debridement and 14 patients managed by traditional method as control group. Wound surface were covered with polyvinyl alcohol foams with embedded drainage tubes connected with vacuum bottle (negative pressure of 50 to 60 kPa) after wound surface were debrided and fracture were fixed. Wound closure was performed with secondary suturing, or free flap, or loco-regional flap and mesh-grafts after 5 to 7 days. RESULTS: All wound surface healed completely. No complications (systemic and local) were found. After 4-6 months follow-up on average, the fracture healed well. There was significant difference in time of treatment, total cost of treatment and complication rate between 2 groups (P < 0.01). CONCLUSION: The VS procedure can drain the wound surface completely, decrease infection rate and stimulate the proliferation of granulation tissue. A combination of VS with emergency internal fixation is a simple and effective method in treatment of limbs open fracture and soft tissue dirty defects.

Adolescent↗
PubMed2003

The use of prophylactic flucloxacillin in treatment of open fractures of the distal phalanx within an accident and emergency department: a double-blind randomized placebo-controlled trial.

Open fractures of the distal phalanx commonly present to the Accident and Emergency Department. Controversy surrounds the use of prophylactic antibiotics in treating this injury. A double-blind, prospective, randomized placebo-controlled study was undertaken comparing the use of prophylactic flucloxacillin to placebo in addition to meticulous wound toilet. One hundred and ninety-three adult patients with an open fracture of the distal phalanx were studied. Seven patients developed superficial infections, an overall infection rate of 4%. No patient developed osteitis or a deep wound infection. There were three cases of infection in the 98 patients (3%) in the antibiotic group and four cases of infection in the 95 patients (4%) in the placebo group. A difference of proportion test confirmed no significant difference. It is concluded that the addition of prophylactic flucloxacillin to thorough wound toilet and careful soft-tissue repair of open fracture of the distal phalanx confers no benefit.

Adolescent↗
PubMed1999

An open fracture of the ulna with bone loss, treated by bone transport.

We report a Gustilo and Anderson IIIc fracture of the ulna with 8 cm of bone loss which was reconstructed primarily by the technique of external fixation and bone transport. Five operations were performed over a period of 14 months (treatment index = 52.5 days/cm). A satisfactory functional result was achieved, demonstrating the efficacy of this technique for difficult forearm reconstructions and comparing favourably with other methods of managing large bone and soft tissue defects.

Adult↗