The cutaneous problem of open fractures of the extremities

Abstract Introduction Infection is a major complication of open fractures. Antibiotic-impregnated calcium sulfate (AICS) beads are widely used as an adjuvant to systemic antibiotics. Whilst their efficacy in the secondary prevention of infection is established, we present the first retrospective study evaluating AICS beads in the primary prevention of infection in open fractures. Method 214 open femur and tibia fractures in 207 patients were reviewed over a seven-year period. 148 fractures received only systemic antibiotic prophylaxis. 66 fractures also received AICS beads. The occurrence of acute infection (wound infection and acute osteomyelitis) was recorded, as well as that of long-term complications (chronic osteomyelitis, non-union and death). Results Fractures that received AICS with systemic antibiotics had an overall acute infection rate of 42% (28/66), compared to 43% (63/148) in fractures that received only systemic antibiotics (p > 0.05). There was no significant difference in infection rate even when fractures were stratified by Gustilo-Anderson grade. There was also no significant difference in the rate of long-term complications. Conclusions Our results indicate that the adjuvant use of AICS beads is not effective for the primary prevention of acute infection or long-term complications in open leg fractures. Further research is needed to elucidate the factors influencing the outcomes of AICS use.

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405 Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in The Management of Gustilo IIIB Open Fractures

British Journal of Surgery ◽

10.1093/bjs/znab134.273 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Aljawadi ◽

I Madhi ◽

T Naylor ◽

M Elmajee ◽

A Islam ◽

...

Keyword(s):

Bone Graft ◽

Cortical Thickness ◽

Bone Graft Substitute ◽

Fracture Site ◽

Open Fractures ◽

X Rays ◽

Radiographic Images ◽

Synthetic Bone ◽

Synthetic Bone Graft

Abstract Background Management of traumatic bone void associated with Gustilo IIIB open fractures is challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) had been recently utilised for the management of patients with these injuries. This study aims to assess radiological signs of Cerament-G remodelling. Method Retrospective data analysis of all patients admitted to our unit with IIIB open fractures who had Cerament-G applied as avoid filler. Postoperative radiographic images of the fracture site at 6-weeks, 3-months, 6-months and at the last follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing, and bone cortical thickness at the final follow-up were assessed. Results 34 patients met our inclusion criteria, mean age: 42 years. Mean follow-up time was 20 months. 59% of patients had excellent (>90%) void filling, 26.4% of patients had 50-90% void filling, and 14.6% had < 50% void filling. Normal bone cortical thickness was restored on AP and Lateral views in 55.8% of patients. No residual Cerement-G was seen on X-rays at the final follow-up in any of the patients. Conclusions Our results showed successful integration of Cerament-G with excellent void filling and normal cortical thickness achieved in more than half of the patients.

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Critical Tectonic Limits for Geothermal Aquifer Use: Case Study from the East Slovakian Basin Rim

Resources ◽

10.3390/resources10040031 ◽

2021 ◽

Vol 10 (4) ◽

pp. 31

Author(s):

Stanislav Jacko ◽

Roman Farkašovský ◽

Igor Ďuriška ◽

Barbora Ščerbáková ◽

Kristína Bátorová

Keyword(s):

Heat Flow ◽

Pannonian Basin ◽

Open Fractures ◽

Water Type ◽

Geothermal Heat ◽

The North ◽

Heat System ◽

Volcanic Chain ◽

Saline Solutions

The Pannonian basin is a major geothermal heat system in Central Europe. Its peripheral basin, the East Slovakian basin, is an example of a geothermal structure with a linear, directed heat flow ranging from 90 to 100 mW/m2 from west to east. However, the use of the geothermal source is limited by several critical tectono-geologic factors: (a) Tectonics, and the associated disintegration of the aquifer block by multiple deformations during the pre-Paleogene, mainly Miocene, period. The main discontinuities of NW-SE and N-S direction negatively affect the permeability of the aquifer environment. For utilization, minor NE-SW dilatation open fractures are important, which have been developed by sinistral transtension on N–S faults and accelerated normal movements to the southeast. (b) Hydrogeologically, the geothermal structure is accommodated by three water types, namely, Na-HCO3 with 10.9 g·L−1 mineralization (in the north), the Ca-Mg-HCO3 with 0.5–4.5 g·L−1 mineralization (in the west), and Na-Cl water type containing 26.8–33.4 g·L−1 mineralization (in the southwest). The chemical composition of the water is influenced by the Middle Triassic dolomite aquifer, as well as by infiltration of saline solutions and meteoric waters along with open fractures/faults. (c) Geothermally anomalous heat flow of 123–129 °C with 170 L/s total flow near the Slanské vchy volcanic chain seems to be the perspective for heat production.

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Radical treatment of severe open fractures of extremities by orthoplastic surgery: a 10-year retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02479-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhao Yang ◽

Chao Xu ◽

Yong-Gang Zhu ◽

Jun Li ◽

Zi-Xiang Wu ◽

...

Keyword(s):

Soft Tissue ◽

Infection Rate ◽

Clinical Data ◽

Open Fractures ◽

Soft Tissue Reconstruction ◽

Satisfactory Outcome ◽

Tissue Damages ◽

Tissue Reconstruction ◽

Severe Soft Tissue

Abstract Objective This study aimed to retrospectively analyze clinical data of a series of patients with severe open fractures of extremities (Gustilo IIIb or IIIc), who achieved a satisfactory outcome through radical orthoplastic surgery, so as to provide a reference for determining the treatment of severe open fractures of extremities. Methods The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and January 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. Results The mean (±SD) age of the patients was 38 ± 16 years. A total of 90 open fractures and severe soft tissue damages were analyzed. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. Conclusion The overall rate of infection exhibited a lower tendency in this study compared with previous studies on high-grade open fractures following a two-stage orthopedic approach. The consequence of infection rate and union time was similar to that in previous studies. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

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Antibiotic utilization in open fractures

OTA International ◽

10.1097/oi9.0000000000000071 ◽

2020 ◽

Vol 3 (1) ◽

pp. e071

Author(s):

Yousif Atwan ◽

Theodore Miclau ◽

Emil H. Schemitsch ◽

David Teague

Keyword(s):

Open Fractures ◽

Antibiotic Utilization

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Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01654-8 ◽

2021 ◽

Author(s):

Carolin A. Kreis ◽

Birte Ortmann ◽

Moritz Freistuehler ◽

René Hartensuer ◽

Hugo Van Aken ◽

...

Keyword(s):

Surgical Procedures ◽

Trauma Center ◽

Control Period ◽

Open Fractures ◽

Injury Patterns ◽

Emergency Patient ◽

Emergency Operations ◽

Incidence Proportion ◽

Level I ◽

The Impact

Abstract Purpose In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. Methods All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. Results During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. Conclusion This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

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