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At least 19 recordsLinked to original sources
PubMed1977

Antibiotic and bacteriologic considerations in open fractures.

A prospective study involving 581 open fracture wounds was conducted to evaluate the antibiotic and bacteriologic considerations in the treatment of open fractures. Multiple cultures were taken of each wound, and each wound had formal surgical irrigation and debridement. An organism was present in at least one of the multiple cultures in 62.1% of the cases. Open fractures should be considered as contaminated wounds, and antibiotics are given for treatment rather than prophylaxis.

Adolescent↗
PubMed1979

Use of antimicrobials in the management of open fractures.

The role of antibiotic therapy in open fractures is secondary to adequate debridement, irrigation, and definitive wound care. Experimental and clinical studies indicate that parenteral administration of appropriate antibiotics within three hours after injury helps to prevent wound sepsis. Intial wound cultures of 158 open fracture wounds revealed bacterial growth in 70.3%. Eighty-six were Gram-positive, 57 were Gram-negative, and 32 yielded mixed bacterial growth. Sensitivity studies of these organisms suggest that cephalothin sodium is the most effective antibiotic for prophylaxis. In a prospective study from 1969 to 1975, treatment of 520 patients was as follows: debridement, copious irrigation, and primary closure for types 1 and 2 fractures and secondary closure for type 3 fractures. No primary internal fixation was done except in vascular injuries. Cultures were taken of all wounds and antibiotics were given before surgery and for three days postoperatively. In type 3 open fractures, severe soft tissue injury, and segmental or traumatic amputation, the infection rate was 9%, compared to a 44% infection rate in the retrospective study from 1955 to 1968.

Anti-Bacterial Agents↗
PubMed1975

[Bacterial flora and preventive antibiotic treatment in open fractures].

In 172 patients with open fractures of long tubular bones the wound bacterial flora was studied on their admission to the clinic and in occurrence of suppurative complications. There were no cases of "outdoor" microorganisms being the cause of suppuration. Pathogenic agents of suppurative infection differed from "outdoor" strains in their species content, signs of pathogenicity, sensitivity to antibiotics. As a rule, suppuration was preceded by soft tissues necrosis. Since wound suppuration was produced not by the initial or changed "outdoor" microorganisms but hospital strains, which penetrate in the wound due to inadequate observation of the rules of asepsis and antisepsis in surgical treatment or subsequent dressing, then prophylactic antibioticotherapy should cover mostly sensitivity of hospital bacterial strains. To this end, the study of bacteriological background for each surgical department seems to be absolutely necessary. In a small zone of the soft tissues injury under conditions of secure fixation of bone fragments with Ilizarov apparatus a limited use of antibiotics is believed to be permissible.

Anti-Bacterial Agents↗
PubMed1975

[Therapeutic principles and results in the management of open fractures of the tibial].

In open fractures of the leg, in which because of any reason no primary stable osteosynthesis can be performed, threading with Kirschner wire is preferred by the authors. This method assures adaptation stability, with minimal osteosynthesis. Primary closure of the wound in the soft parts is striven by the authors, - if necessary, even by plastic surgery. If primary healing of the wound is obtained and also the other conditions are favourable, the treatment after 7-10 days is the same as after covered fractures: stable osteosynthesis is performed. On the other hand, if suppuration of the wound occurs, the opposing fixed fracutre bone ends assure favourable conditions for the successful surgical treatment of the fracture. A further advantage of the method is that it may be performed without special instruments and without greater surgical experience. The results obtained with this surgical treatment of open leg fractures in the 4 years' material of the Traumatological Department of the First Surgical Clinique of the University Medical School, Pécs, are discussed by the authors.

Fracture Fixation↗
PubMed1975

[Experience with the treatment of open fractures].

The number of the injuries and of the open fractures is steadily increasing. These latter are regularly due to traffic accidents. Characteristics of the open fractures are the extended lesion of the soft parts and the piece-like fractures. The treatmend depends on the patient's general state, the extension of the lesion of the soft parts, the contamination and the infection of the wound, as well as on the localization and the type of the fracture. In the case of proper indication the osteosynthesis yields satisfactory results, but it is not always to be performed and its use to exposed to dangers. The conservative treatment assures good results, if the lesion of the soft parts is minimal, the reduction of the dislocation is easily accoplished and the bone ends are to be held together. On the other hand, the method is unsuitable, if extended lesion of the soft parts occurs, as well as in the treatment of multifragmental fractures. In this group of the open fractures we must try to find other, new methods.

Bone Plates↗
PubMedDate not supplied

The role of early internal fixation in the management of open fractures.

A series of 101 victims of multiple trauma and open fractures were treated by early open reduction and internal fixation. Some of the fractures included associated vascular injury. Some of the patients had extensive intraarticular fractures. Femur fractures in the elderly were included. All wounds were left open. In 94 patients, the early infection rate was 1.9% in small clean open (type I) wounds, 8% in large open (type II) wounds, and 41% in extensively contused large open (type III) wounds. In 94 cases the overall infection rate was 10.6%. In only one infection (1%) a long-term chronic osteomyelitis ensued; there were no non-unions in long bone fractures. Open fractures with type I wounds have the same infection rate as reported for closed fractures. In fractures with types II and III wounds salvage of limb, life, or joint function must justify the high risk of infection. Immediate plate fixation of severe open fractures of the tibia could save a limb from amputation. Closed intramedullary nailing of open fractures of the femur carries a high rate of success.

Adolescent↗
PubMed1975

[Current problems in the treatment of open fractures].

The paper evidently does not discuss several important problems of the management of open fractures, but it is confined to the exposition of some fundamental rules of their traitment. Nowadays, the treatment of open fractures is to be decided individually for all cases. A great number of patients with open fracture owe their recovery to the proper first aid care at scence of accident. This is also in respect of the further treatment in the hospital of great importance. Exagerated activity is usually superfluous in the treatment of open fractures. Less and more proper management is often more useful for the injured patient.

Bone Plates↗
PubMed1992

Teicoplanin in open fractures: a preliminary report.

The occurrence of infection following open fractures varies with the severity of the fracture and associated soft tissue damage. In order to study the effect of antibiotics given prophylactically, teicoplanin has been used in a prospective study. On admission, fractures were graded according to the severity of the tissue damage: Type I--soft tissue injury less than 1 cm Type II--soft tissue injury more than 1 cm. Type III fractures characterized by extensive soft tissue and bone damage were not included in the study. Type I patients were given a single dose of teicoplanin, 400 mg i.v.; Type II patients were given a single dose of teicoplanin, 400 mg i.v., followed by two further intravenous injections at 12 and 24 hours. Patients were assessed for the presence of wound and bone infections and follow up was for 1 year. Preliminary results, predominantly from Type II fractures involving long bones, show that teicoplanin is effective in lowering the incidence of infection following open fractures.

Adolescent↗
PubMed1975

[Infectious complications of 227 open fractures of the leg].

Out of 557 open fractures of the leg we have analysed 472 cases in respect of recovery. We tried to discrive the relationship between the infection and the severity of the lesion and the methods of treatment resp. We have analysed also the further course of the infect.on. In our material considerable risk of the infections in the case of open leg fractures was found, since the incidence of all infections corresponded--in accordance with the data of the literature--to 16,7% of the appreciable cases. Significant relationship between the occurrence of infections and the severity of the lesion was found. In the material analysed according to the ACD code the incidence of infections is in the severely injured patients three times as much as in the case of slight or moderately severe groups. The occurrence of posttraumatic osteitis corresponds to 9,11%--this latter is similarly in relation with the severity of the lesion. The infection leads to the protraction of the osseous union,--however, no convincing data were found in the authors' material in respect of the relationship between the infection and the methods of treatment. The course and the proportion of healing of the infected cases correspond to the mean values reported in the literature. On the basis of their great material it is stated by the authors that only in the case of lesions with identical or at the least similar severity comparison of the results of recovery or of the complications is possible and suitable.

Accidents↗
PubMed1976

Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses.

In 673 open fractures of long bones (tibia and fibula, femur, radius and ulna, and humerus) treated from 1955 to 1968 at Hennepin County Medical Center, Minneapolis, Minnesota, and analyzed retrospectively, the infection rate was 12 per cent from 1955 to 1960 and 5 per cent from 1961 to 1968. In a prospective study from 1969 to 1973, 352 patients were managed as follows: débridement and copious irrigation, primary closure for Type I and II fractures and secondary closure for Type III fractures, no primary internal fixation except in the presence of associated vascular injuries, cultures of all wounds, and oxacillin-ampicillin before surgery and for three days postoperatively. In 158 of the patients in the prospective study the initial wound cultures revealed bacterial growth in 70.3 per cent and the infection rate was 2.5 per cent. Sensitivity studies suggested that cephalosporin is currently the prophylactic antibiotic of choice. For the Type III open fractures (severe soft-tissue injury, segmental fracture, or traumatic amputation), the infection rates were 44 per cent in the retrospective study and 9 per cent in the prospective study.

Arteries↗
PubMed1979

Open fractures of the shaft of the tibia: analysis of wound and fracture treatment.

Cooperation between orthopaedic and plastic surgeons is an important factor in the treatment of open fractures. In this article a report is made on a retrospective study of a 5-year series of open fractures of the shaft of the tibia treated at the University Hospital in Uppsala between 1972 and 1976. The study proves that the change to external fixation of these fractures and 'open' treatment of the wounds has meant that to a large extent the previous use of pedicle flaps to cover skin defects has been replaced by split skin grafts. The results in the reported series were good, with adequate function in most cases. The final results may, however, be less good than they appeared at this early review time.

Adolescent↗
PubMedDate not supplied

Review of the management of open fractures.

This article presents a literature review of the evaluation and management of open fractures. A case report of a patient having sustained a type II open fracture of the hallux is presented. Debridement, tetanus prophylaxis, reduction and stabilization, and intravenous antibiosis are the hallmarks for prompt and appropriate treatment.

Adult↗