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Special Issue on Open Fractures and Fracture-Related Infections

Open fracture management

Critical issues

Miclau, Theodore MD

Author Information
doi: 10.1097/OI9.0000000000000074
  • Open

Abstract

1 Introduction

Open fractures are among the most commonly encountered musculoskeletal injuries.[1] Open tibia fractures, in particular, have received increased attention due to their prevalence and severity.[2] These fractures are the second-most common open bone injury,[3] occurring in nearly 1-quarter of all tibial diaphyseal fractures,[4] with estimates of 17 to 23 open tibia fractures per 100,000 person years.[5] Additionally, approximately 60% of open tibial fractures result from higher energy injuries, which are associated with severe soft tissue lesions.[6] Ultimately, these can lead to significant complications that include infection, wound-healing problems, and impaired bone healing,[7,8] potentially leading to long-term disability.

The management goals are to achieve well-aligned bone union, avoid complications, and restore function. While some of the factors that contribute to the ultimate outcomes are patient-related, others are influenced by treatment choices. Perhaps as critical as any acute care decisions they face, surgeons’ early management of open injuries may significantly influence long-term outcomes. Although evidence-based practice recommendations to guide decision-making continue to grow, several areas remain inconclusive.

With the goal of summarizing the current understanding of best evidence for the acute treatment of open fractures, this supplement addresses many of the most critical controversies. The topics include antibiotic selection and administration, surgical timing, management of bone defects, and coverage of soft-tissue wounds as well as management of fracture-related infections. Further, this summary will address gaps in the literature and needs for future study to improve care of these injuries worldwide.

References

1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–697.
2. Petrisor BA, Bhandari M, Schemitsch E. Buchholz RW, Heckman JD, Court-Brown, C Tornetta PA 3rd. Tibia and fibula fractures. Rockwood and Green's Fractures in Adults. 7th edPhiladelphia, PA: Lippincott Williams & Wilkins; 2010.
3. Bugler KE, Clement ND, Duckworth AD, et al. Court-Brown CMThe epidemiology of open fractures in adults: a 15 year review. Injury. 2012;43:891–897.
4. McBernie J. Court-Brown CMThe epidemiology of tibial fractures. J Bone Joint. 1995;77:417–421.
5. Weiss RJ, Montgomery SM, Ehlin A, et al. Decreasing incidence of tibial shaft fractures between 1998 and 2004: information based on 10,627 Swedish inpatients. Acta Orthop. 2008;79:526–533.
6. Court-Brown CM, Rimmer S, Prakash U, et al. The epidemiology of open long bone fractures. Injury. 1998;29:529–534.
7. Mundi R, Chaudhry H, Nirropan G, et al. Open tibial fractures: updated guidelines for management. JBJS Rev. 2015;3:1–7.
8. Melvin JS, Dombroski DG, Torbert JT, et al. Open tibial shaft fractures: I. Evaluation and initial wound management. J Am Acad of Orthop Surg. 2010;18:10–19.
Keywords:

antibiotic; bone defect; open fracture; timing; wound

Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.