scholarly journals Immediate Care of Open Extremity Fractures: Where Can We Improve?

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
R. Walton ◽  
J. Manara ◽  
S. E. Elamin ◽  
I. Braithwaite ◽  
E. Wood
Keyword(s):  
Acute Care ◽  
Bone Fractures ◽  
Working Hours ◽  
District General Hospital ◽  
Open Fractures ◽  
Care Staff ◽  
Long Bone ◽  
Initial Management ◽  
Clinical Consequences

Clear guidelines are set by the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133), excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4%) having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.

scholarly journals Management of Open Fractures in Low-Income Countries: a Daunting Task

2021 ◽  
Vol 2 (3) ◽  
pp. 9-16
Author(s):  
Jean Baptiste Ramampisendrahova ◽  
Mamisoa Bodohasina Rasamoelina ◽  
Tsiahoana Jean Floris Tata ◽  
Rado Razafimahatratra ◽  
Gaëtan Duval Solofomalala
Keyword(s):  
Low Income ◽  
Bone Fractures ◽  
Insurance Coverage ◽  
Open Fractures ◽  
University Hospital ◽  
Low Income Countries ◽  
Long Bone ◽  
Definitive Treatment ◽  
Long Bones ◽  
Daunting Task

Abstract The management of open fractures was a challenge from antiquity to the present day. The objective of this study is to report the difficulties of the management of open fractures of long bones in low-income countries. This was a retrospective cohort study of the files of patients admitted for open fracture of long bones in the Department of Orthopedic Surgery and Traumatology of the Anosiala University Hospital Center for four years. Forty-two open long bone fractures were collected. The average age of the patients was 36.3 years of which 73.8% were subject of working age in the age group of 20 to 60 years and 73.8% of the cases were following the accident of the road. Most of the wounded had arrived at the hospital by bush taxi. The tibia was the most affected bone (71.4%). Gustilo IIIA type open fractures were the most observed (38.1%). Only 26.3% of patients had received surgical debridement before the sixth hour. 76.2% had no care before arriving at the hospital, 14.3% had emergency care at the basic health center and 9.5% were already being treated by the traditional healer. Definitive treatment of the fracture was dominated by the external fixator (38.1%) and orthopedic treatment (26.2%).               In low-income countries, the management of open fractures remains a daunting task. The main factors limiting the management of open fractures were the poverty of the population, the lack of health insurance coverage and the retard in arriving at the hospital. Keywords: open fractures, management, low-income, country 

Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures

2020 ◽  
Author(s):  
Farzad Amouzadeh Omrani ◽  
Mohsen Elahi ◽  
Mohammad Mahdi Sarzaeem ◽  
Shahram Sayadi ◽  
Hamed Farzaneh
Keyword(s):  
Antibiotic Therapy ◽  
Intramedullary Nailing ◽  
Infection Rate ◽  
Bone Fractures ◽  
Articular Surface ◽  
Standard Of Care ◽  
Open Fractures ◽  
Long Bone ◽  
The Difference ◽  
Im Nailing

Background: Intramedullary nailing (IM nailing) is the standard of care for the treatment of most diaphyseal lower extremity fractures. A few studies have assessed and compared the infection rate following reamed and unreamed IM nailing in open long bone fractures. In the present study, we attempted to compare the infection rate between two procedures in open fractures of tibia. Methods: In this prospective study, we included consecutive patients suffering from open fractures of tibia (Gustilo subtypes II or IIIA) who required IM nailing. Patients younger than 16 years old, other Gustilo types (I, IIIB, and IIIC), fractures reaching to the tibial plateau articular surface, and simultaneous fractures of other bones in the extremity were excluded. All patients were followed up for one year to assess the postoperative infection rate. Results: Of 59 patients, 37 underwent reamed IM nailing and 22 underwent unreamed IM nailing. In reamed group, 4 cases (10.8%) experienced an infection requiring reoperation and antibiotic therapy, while in the unreamed group, it was 5 cases (22.7%). The difference between the groups was not statistically significant. Conclusion: Reamed and unreamed IM nailing procedures for fractures of tibia have similar outcome regarding long-term postoperative infections that require reoperation and antibiotic therapy.

Fracture-related infection in long bone fractures: a comprehensive analysis of the economic impact and influence on quality of life

Injury ◽  
2021 ◽  
Author(s):  
Jorien Iliaens ◽  
Jolien Onsea ◽  
Harm Hoekstra ◽  
Stefaan Nijs ◽  
Willy E. Peetermans ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Economic Impact ◽  
Bone Fractures ◽  
Comprehensive Analysis ◽  
Long Bone ◽  
Long Bone Fractures

Outcome of Open Long Bone Fractures in Dogs Stabilized with Linear External Skeletal Fixator

2021 ◽  
Author(s):  
Tejpal Singh ◽  
Ashwani Kumar ◽  
Rahul Kumar Udehiya ◽  
Kirandeep Kaur Gill ◽  
Tejinder Singh Rai ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Fracture ◽  
Bone Fractures ◽  
Open Fractures ◽  
Long Bone ◽  
Type I ◽  
Group Iii ◽  
Long Bone Fractures ◽  
Group I ◽  
Tract Infections

Background: External skeletal fixator (ESF) has been recommended as biological method to stabilize open fracture as it does not involves the wound site, besides protecting adjacent soft tissue structures. Considering the advantages of ESF, this study was envisaged with an objective to study the outcome of open fractures of radius-ulna and tibia-fibula stabilized with linear ESF in dogs.Methods: This study included 17 dogs suffering from open long bone fractures of radius-ulna and tibia-fibula, divided into three groups; linear ESF type I or II (group I, n=8) and type III (group II, n=3). In group III (n=6), open fractures were initially treated using conservative methods i.e management of open wound till complete healing followed by delayed internal fixation using intramedullary pin or bone plating.Result: Majority of the open fractures of radius-ulna and tibia-fibula were transverse (64.71%), involving distal third diaphysis (47.06%) in heavy weight (54.55%), 1-3 year old (64.71%), non-descript (35.29%), male (88.23%) dogs due to automobile accidents (58.82%). Neutrophilic (81.47±4.45%) leukocytosis (24610±2461.88 per cumm) and elevated levels of alkaline phosphatase and creatine kinase were observed. Staphylococcus spp. was the common isolated bacteria sensitive to Gentamicin, Cefotaxime, Tobramycin, Amikacin and Neomycin. High per cent fractures (83.33%) in group III had acceptable functional outcome as compared to fractures treated with linear ESF (55.55%) in groups I and II. Osteomyelitis due to pin tract infections was the major complication (8/11; 72.7%) recorded in ESF groups (Group I and II) that lead to delayed and/or nonunion. Weight bearing score improved markedly after removal of the ESF frame. In conclusions, immediate fixation of the long bone fracture using linear ESF in the presence of open contaminated / infected wounds leads to unacceptable outcome. Poor animal compliance, pin tract discharge, osteomyelitis, delayed union and nonunion are major complications associated with linear ESF. Conservative management of the open fracture wound using standard treatment for 2-3 weeks till complete wound healing followed by internal fixation with intramedullary pin or bone plate is recommended for open long bone fractures in dogs.

scholarly journals The National Trend in Quality of Emergency Department Pain Management for Long Bone Fractures

2007 ◽  
Vol 14 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Tamara S. Ritsema ◽  
Gabor D. Kelen ◽  
Peter J. Pronovost ◽  
Julius Cuong Pham
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Bone Fractures ◽  
Long Bone ◽  
National Trend ◽  
Long Bone Fractures

The national trend in quality of emergency department pain management for long bone fractures

Acute Pain ◽  
2007 ◽  
Vol 9 (2) ◽  
pp. 100-101
Author(s):  
T.S. Ritsema ◽  
G.D. Kelen ◽  
P.J. Pronovost ◽  
J.C. Pham
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Bone Fractures ◽  
Long Bone ◽  
National Trend ◽  
Long Bone Fractures

scholarly journals Use of ozone in bone pathologies of the dog [abstract]

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Paolo Scrollavezza
Keyword(s):  
Spinal Cord ◽  
Blood Loss ◽  
Orthopedic Surgery ◽  
State Of The Art ◽  
Bone Fractures ◽  
Open Fractures ◽  
Long Bone ◽  
Acute Normovolemic Hemodilution ◽  
Normovolemic Hemodilution ◽  
Regenerative Power

The author presents his extended experiences using ozone to treat different orthopedic pathologies in the dog. He illustrates the state of the art of how ozone can be useful as adjuvant or as a treatment in osteomyelitis and osteochondrosis, arthrosis and arthritis, malunion and nonunion fractures, open fractures, and spinal cord and vertebral disease. In particular, numerous experiences will be described on the benefits of major ozone autohemotherapy (MAHT), minor ozone autohemotherapy (mAHT) and local ozone application in septic arthritis and open fractures; diseases in which antiseptic, healing and regenerative power of ozone seems more evident. Author also describes his experiences about ozonized Acute Normovolemic Hemodilution (OANH), an innovative technique to be used in synthesis of long bone fractures in the dog where significant blood loss is expected during orthopedic surgery.

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