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Use of the Dedicated Orthopaedic Trauma Room for Open Tibia and Femur Fractures

Does It Make a Difference?

Steeby, Shaun F. MD*; Harvin, William H. MD; Worley, John R. MD; Della Rocca, Gregory J. MD, PhD; Volgas, David A. MD; Stannard, James P. MD; Crist, Brett D. MD

doi: 10.1097/BOT.0000000000001232
Original Article
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Objective: To assess the “Dedicated Orthopaedic Trauma Operating Room” (DOTOR) effect on management and outcomes of open tibia and femur fractures.

Design: Retrospective chart review.

Location: University Level I Trauma Center.

Methods: Patients categorized into those managed in the DOTOR versus those managed in a standard on-call operating room (OCOR). Data collected include patient and injury characteristics, time to debridement, and patient outcomes.

Results: A total of 297 patients with 347 open tibia and femur fractures were included; 154 patients (174 fractures) were managed in the DOTOR group and 143 patients (170 fractures) were managed in the OCOR group. The average time to debridement was significantly longer for DOTOR (12.9 hours) versus OCOR (5.4 hours). The DOTOR group was 9 times less likely to undergo debridement within 6 hours. The number of patients debrided within 24 hours was similar (90% for DOTOR vs. 96% OCOR). The rate of primary fracture union was significantly higher in the DOTOR (73.2% vs. 56.6%). OCOR patients were twice as likely to have an unplanned surgery. Rates of infection, nonunion, and amputation were similar.

Conclusion: Despite earlier access to the Operating room for debridement in the OCOR group, there was no difference in the infection rate compared with the DOTOR group. However, patients managed in the DOTOR group were more likely to go on to uncomplicated fracture union and less likely to have an unplanned surgery.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department Chair and Orthopaedic Trauma Surgeon, Stormont Vail Medical Center, Topeka, KS;

Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX; and

Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO.

Reprints: Brett D. Crist, MD, Department of Orthopaedic Surgery, University of Missouri School of Medicine, One Hospital Drive N116, Columbia, MO 65212 (e-mail: cristb@health.missouri.edu).

The authors report no conflict of interest.

Presented as a poster at the 2017 Orthopaedic Trauma Association's annual meeting, Vancouver, BC, Canada, and as a paper at the Mid-America Orthopaedic Association's Annual Meeting, Amelia Island, FL, April 20, 2017.

Accepted May 08, 2018

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