scholarly journals Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 83-91
Author(s):  
Laveta Stewart ◽  
Faraz Shaikh ◽  
William Bradley ◽  
Dan Lu ◽  
Dana M Blyth ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Tissue Injury ◽  
Hazard Analysis ◽  
Soft Tissue Injury ◽  
Open Fractures ◽  
Severe Injury ◽  
Wound Classification ◽  
Military Patients ◽  
Improvised Explosive

Abstract We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009–2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25–2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and >4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.

The principles of managing open fractures

2014 ◽  
Vol 100 (1) ◽  
pp. 20.1-25
Author(s):  
R Walker ◽  
S Middleton ◽  
S A Stapley
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Open Fracture ◽  
Open Fractures ◽  
Improvised Explosive Device ◽  
Limb Fracture ◽  
Explosive Device ◽  
Improvised Explosive

AbstractAny fracture of a bone which communicates with the outside environment via a wound in the skin is classified as an open fracture. This may be from penetration by sharp objects from the exterior, laceration caused by the fracture fragments, or shearing forces that tear or de-glove soft tissue from a limb. These injuries vary in mechanism and severity, ranging from a broken finger caught in a bulkhead door to a catastrophic lower limb fracture suffered from an improvised explosive device (IED). We address the management principles that can be applied to all open fractures regardless of cause.

scholarly journals Results of non-microvascular flap cover surgery for management of soft tissue injury in open fractures of leg bones

2016 ◽  
Vol 15 (10) ◽  
pp. 56-61
Author(s):  
Swayam Prakash Tripathy ◽  
Mohammad Zuber ◽  
Aanand Gautam ◽  
Arun Bhatnagar ◽  
Suneet Tandon ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Open Fractures ◽  
Microvascular Flap ◽  
Flap Cover ◽  
Leg Bones

Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome

2004 ◽  
Vol 86 (11) ◽  
pp. 2569 ◽  
Author(s):  
Keith A. Heier ◽  
Anthony F. Infante ◽  
Arthur K. Walling ◽  
Roy W. Sanders
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Open Fractures

scholarly journals Cefazolin sodium pentahydrate combined with vacuum sealing drainage in the treatment of open fracture complicated with soft tissue injury

2020 ◽  
Vol 66 (4) ◽  
pp. 430-436
Author(s):  
Wenjie Lou ◽  
Kai Zou ◽  
Zhongbin Yu ◽  
Song Qin ◽  
Kai Wang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Serum Levels ◽  
Control Group ◽  
Observation Group ◽  
Tnf Α ◽  
Cefazolin Sodium ◽  
Vacuum Sealing Drainage

SUMMARY OBJECTIVE To investigate the clinical efficacy of cefazolin sodium pentahydrate combined with vacuum sealing drainage (VSD) in the treatment of open fracture complicated with soft tissue injury. METHODS Sixty-three patients with open fracture complicated with soft tissue injury were divided into observation (n = 33) and control (n = 30) groups. After surgical reduction, fixation, and repair of the fractures, the control group was treated with VSD for 10 days, and the observation group was treated with cefazolin sodium pentahydrate based on VSD for 10 days. The infection control time was recorded. After treatment, the pain of patients was evaluated. Before and after treatment, the serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α), cortisol, epinephrine, norepinephrine, and glucose were detected. After 6 months of treatment, the total effective rate of the treatment was evaluated. RESULTS The infection control time and Visual Analogue Scale score after treatment in the observation group were significantly lower than in the control group, respectively (P < 0.05). After the treatment, the serum levels of CRP, IL-6, IL-8, TNF-α, cortisol, epinephrine, norepinephrine, and glucose in each group were significantly lower than before the treatment (P < 0.05), and each index in observation was significantly lower than in the control group (P < 0.05). CONCLUSIONS In the treatment of open fractures complicated with soft tissue injury, cefazolin sodium pentahydrate combined with VSD can effectively reduce inflammation and stress, thus improving the treatment efficacy.

Role of Reamed and Unreamed Interlocking Intermedullary Nailing in the Management of Compound Fracture of Shaft Tibia

2014 ◽  
Vol 23 (Number 2) ◽  
pp. 21-26
Author(s):  
Md. F Ahmed ◽  
Md. M Rahman ◽  
K Dipu ◽  
Md. N Islam
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Deep Infection ◽  
Medullary Canal ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Non Union ◽  
Interlocking Nailing ◽  
Open Injury

Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. The study was done to compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

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