Open Fracture Management

Background: Road traffic injury (RTI) is the largest cause of death amongst 15–39-year-old people worldwide, and the burden of injuries such as open tibia fractures are rapidly increasing in Malawi. This study aims to investigate disability and economic outcomes of people with open tibia fractures in Malawi and improve these with locally delivered implementation of open fracture guidelines. Methods: This is a prospective cohort study describing function, quality of life and economic burden of open tibia fractures in Malawi. In total, 160 participants will be recruited across six centres and will be followed-up with face-to-face interviews at six weeks, three months, six months and one year following injury. The primary outcome will be function at one year measured by the short musculoskeletal functional assessment (SMFA) score. Secondary outcomes will include quality of life measured by EuroQol EQ-5D-3L, catastrophic loss of income and implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) at one year. A nested pilot pre-post implementation study of an interventional bundle for all open fractures will be developed based on other implementation studies from low- and middle-income countries (LMICs). Regression analysis will be used to model and investigate associations between SMFA score and fracture severity, infection and the pre- and post-training course period. Outcome: This prospective cohort study will report patient reported outcomes from open tibia fractures in low-resource settings. Subsequent detailed evaluation of both the clinical and implementation components of the study will promote sustainability of improved open fractures management in the study sites and further scale-up of open fracture management guidelines. Ethics: Ethics approval has been obtained from the Liverpool School of Tropical Medicine and College of Medicine Research and Ethics committee.

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245. Risk Factors Associated with Open Fracture Complications Following Antibiotic Prophylaxis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.447 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S231-S231

Author(s):

Elizabeth Cusack ◽

Kaylee Maynard ◽

Ted Louie ◽

John Gorczyca ◽

Courtney M Jones ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Prophylaxis ◽

Guideline Adherence ◽

Open Fracture ◽

Univariate Analysis ◽

Bivariate Analysis ◽

Type I ◽

Delayed Presentation ◽

Fracture Classification ◽

Fracture Management

Abstract Background Surgical site infection is concerning after an open fracture. The Eastern Association for the Surgery of Trauma guidelines provide antibiotic selection and duration recommendations based on open fracture type. Risk factors for open fracture complications (e.g. infection, acute kidney injury [AKI], multi-drug resistant organisms [MDRO], or Clostridioides infection [C. difficile]) and overall guideline adherence are unclear at our institution. Methods This was a single center, retrospective study of adult patients with an open fracture who received antibiotic prophylaxis and were admitted for at least 24 hours between March 2011 and October 2020. Patients were excluded if open fracture was due to gun-shot wound, had a history of renal replacement therapy, MDRO, or C. difficile infection, were an outside hospital transfer, received antibiotics for another indication, or had a delayed presentation. The primary outcome was to identify risk factors for infection and secondary outcomes to identify risk factors for AKI, MDRO, C. difficile infection, and to evaluate guideline adherence. Patient demographics including injury details and management, microbiologic cultures, and antibiotic information were collected. Data were analyzed by univariate analysis, as appropriate, and logistic regression. Results A total of 401 patients met study criteria; median age 46 years, 62% male, and 77% white. Fracture classifications were similar: 30% type I, 39% type II, and 30% type III. Infection occurred in 18% of patients, AKI in 18%, MDRO in 3%, and no patients developed C. difficile. Of those with culture-positive infection, 51% grew gram-positive organisms. In bivariate analysis, fracture classification (p=0.023), medical fracture management (p=0.034), and antibiotic choice (p=0.004) were associated with infection. The only independent risk factor associated with AKI was receiving a nephrotoxic medication (p=0.012). Eighty-one percent received guideline adherent antibiotics and of those that received too narrow antibiotics, 36% developed an infection (p=0.004). Conclusion Appropriate fracture classification and antibiotic choice is crucial to reduce infection following open fracture. Reducing concomitant exposure to nephrotoxic agents may reduce the risk of AKI. Disclosures All Authors: No reported disclosures

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Norwegian Open Fracture Management System: Outcomes After 10 Years Working in Low-Resource Settings in Cambodian Hospitals

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21001291 ◽

2022 ◽

pp. 1-11

Author(s):

Nenad B. Tajsic ◽

Sigrunn H. Sørbye ◽

Sophy Nguon ◽

Vannara Sokh ◽

Aymeric Lim

Keyword(s):

Limb Salvage ◽

Management System ◽

Open Fracture ◽

Lower Limbs ◽

Limb Salvage Surgery ◽

External Fixators ◽

Soft Tissue Reconstruction ◽

Low Resource Settings ◽

Low Resource ◽

Fracture Management

Abstract Introduction: The treatment of open lower limb fractures represents a major challenge for any trauma surgeon, and this even more so in resource-limited areas. The aim of the study is to describe the intervention, report the treatment plan, and observe the effectiveness of the Norwegian Open Fracture Management System in saving lower limbs in rural settings. Materials and Methods: A retrospective and prospective interventional study was carried out in the period 2011 through 2017 in six rural hospitals in Cambodia. The fractures were managed with locally produced external fixators and orthosis developed in 2007. Based on skills and living locations, two local surgeons and one paramedic without reconstructive surgery experience were selected to reach the top of the reconstructive ladder and perform limb salvage surgeries. This study evaluated 56 fractures using the Ganga Hospital Open Injury Score (GHOIS) for Gustilo-Anderson Type IIIA and Type IIIB open fracture classification groups. Results: The primary success rate in open tibia fractures was 64.3% (95% CI, 50.3 - 76.3). The average treatment time to complete healing for all of the patients was 39.6 weeks (95% CI, 34.8 - 44.4). A percentage of 23.2% (95% CI, 13.4 - 36.7) experienced a deep infection. Fifteen of the patients had to undergo soft tissue reconstruction and 22 flaps were performed. Due to non-union, a total of 15 bone grafts were performed. All of the 56 patients in the study gained limb salvage and went back to work. Conclusion: The given fracture management program proves that low-resource countries are able to produce essential surgical tools at high quality and low price. Treatment with external fixation and functional bracing, combined with high-level training of local surgeons, demonstrates that a skilled surgical team can perform advanced limb salvage surgery in low-resource settings.

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British Orthopaedic Association Standard for Trauma (BOAST): Open fracture management

Injury ◽

10.1016/j.injury.2019.12.034 ◽

2020 ◽

Vol 51 (2) ◽

pp. 174-177

Keyword(s):

Open Fracture ◽

Fracture Management ◽

British Orthopaedic Association

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VAC Use in Open Fracture Management

OrthoMedia ◽

10.1302/3114-210439 ◽

2021 ◽

Keyword(s):

Open Fracture ◽

Fracture Management

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Delays in open fracture management: where do they occur?

Injury ◽

10.1016/j.injury.2004.01.014 ◽

2004 ◽

Vol 35 (11) ◽

pp. 1107-1109 ◽

Cited By ~ 2

Author(s):

Robert U. Ashford ◽

Antonio Frasquet-Garcia ◽

Kalpit K. Patel ◽

Peter Campbell

Keyword(s):

Open Fracture ◽

Fracture Management

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Experiences of lower limb open fracture management at the Royal United hospital, Bath

International Journal of Surgery ◽

10.1016/j.ijsu.2012.06.457 ◽

2012 ◽

Vol 10 (8) ◽

pp. S86

Author(s):

William Carlino ◽

Caroline Bartolo ◽

Gavin Jennings

Keyword(s):

Lower Limb ◽

Open Fracture ◽

Fracture Management

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KUMAN DAN KEPEKAAN ANTIMIKROBA DI KASUS PATAH TULANG TERBUKA

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v19i2.1062 ◽

2018 ◽

Vol 19 (2) ◽

pp. 88

Author(s):

Yanty Tandirogang ◽

Tenri Esa ◽

Nurhayana Sennang

Keyword(s):

Retrospective Study ◽

Bacterial Contamination ◽

Open Fracture ◽

Standard Procedure ◽

Prophylactic Antibiotics ◽

Sensitivity Test ◽

Surgical Patients ◽

Antibiotics Resistance ◽

Klebsiella Pneumonia ◽

Fracture Management

About 70% of all nosocomial infections occur in surgical patients. In open fracture, there is contact with the environment or unsterilebody compartment, so that bacterial contamination may occur and cause infection. Besides debridement, prophylactic antibiotics havebeen used as a standard procedure in the open fracture management. This procedure may cause antibiotics resistance leading to increasethe number of infections. The aim of this retrospective study was to know the characteristics, microbial pattern, and sensitivity of 35cultures and sensitivity test of open fracture patients in Orthopaedics Department of Wahidin Sudirohusodo Hospital during the period ofJune 2009–June 2010. The most common bacteria found were Proteus mirabilis (26%), Klebsiella pneumonia (14. 8%), and Providenciaalcalifaciens (14%). The sensitivity test for antimicrobials showed that most of the 19 antimicrobials, were resistant. The sensitiveantimicrobial is Meropenem.

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