Analysis of 511 Open Fractures

Gustilo, Ramon B.; Simpson, Lex A.; Nixon, Ryan; Ruiz, Angel; Indeck, Walter

doi:10.1097/00003086-196909000-00020

Cited by 82 publications

(25 citation statements)

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“…Alguns fatores preditivos são sempre considerados como significantes nos trabalhos, mas outros foram abandonados no decorrer das pesquisas pela ausência de comprovação de sua validade (8,9,13) .…”

Section: Discussionunclassified

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Fatores preditivos de infecção em pacientes com fraturas expostas nos membros inferiores

Lima¹,

Zumiotti²,

Uip³

et al. 2004

Acta ortop. bras.

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134 pacientes com fraturas expostas dos membros inferiores dos tipos II, IIIA, IIIB e IIIC foram estudados prospectivamente entre fevereiro de 1998 e maio de 2000 no Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo para determinar os fatores de risco de infecção previsíveis Todos os pacientes foram registrados em um protocolo no qual eles tiveram amostras de fragmentos ósseos iniciais coletadas para cultura bacteriana, avaliação de condições clínica e administração precoce de antibiótico. Durante a abordagem inicial, as causas das fraturas, o tempo de exposição da fratura e o local onde os primeiros socorros foram recebidos foram observados. Durante o debridamento inicial, o volume de transfusão sangüínea, a classificação clinica ASA, o tempo cirúrgico, o ferimento cirurgico e o tipo de estabilização esquelética foram observados. Uma análise univariável foi realizada para identificar os riscos pervisíveis estatisticamente significantes para o desenvolvimento de infecções, com os seguintes resultados: tempo de exposição da fratura (p=0.0201), local dos primeiros socorros (p=0.400), tipo de fratura (p=0.0130), classificação ASA (p=0.0005), volume de transfusão de sangue (p=0.0002) tipo de osso fraturado (p=0.0052), tipo de acidente (p=0.0450), ferimento cirúrgico (p=0.0024), estabilização esquelética (p=0.0446), cultura bacteriana positiva na admissão (p=0.5290) e cirurgias concomitantes (p=0.1867). As variáveis com associação significante com a infecção foram introduzidas em uma equação de regresão multivariada (modelo logístico) para identificar as com efeitos independentes dos outros fatores. O modelo logístico final foi obtido e demonstrou as probabilidades de infecção nas fratruras expostas estudadas. Os riscos relativos revelados no modelo logístico final foram : volume de transfusão sangüínea (mais do que 1 unidade) - 6.4;classificação ASA nível III - 5.2; fixação interna do osso (imediata) - 3.9; osso fraturado (femur) - 3.5 and ferimento aberto - 3.0

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Section: Discussionunclassified

“…Some predictive factors have always been considered as significant in papers, but others have been rejected during research due to the absence of proofs of their effectiveness (8,9,13) .…”

Section: Discussionmentioning

confidence: 99%

Fatores preditivos de infecção em pacientes com fraturas expostas nos membros inferiores

Lima¹,

Zumiotti²,

Uip³

et al. 2004

Acta ortop. bras.

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“…In the other two treatment groups the only complication recorded was superficial thromboplebitis in one patient in each of the groups. (Brown 1973a, b, Copeland & Enneking 1965, Daland 1934, Davis 1948, Edwards 1965, Epps & Adams 1961, Gustilo 1971, Gustilo & Anderson 1976, Gustilo et al 1969. In these reports it is stated that the most important factor determining the outcome of healing is the soft tissue damage, the extent of which is directly related to the energy of the trauma.…”

Section: Complications Of Treatmentmentioning

confidence: 99%

Antibiotic Prophylaxis in Open and Closed Fractures:A Controlled Clinical Trial

Bergman¹

1982

Acta Orthopaedica Scandinavica

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“…High-energy lower extremity trauma with massive bone and soft tissue loss poses a challenge for orthopedic and reconstructive surgeons. Higher Gustilo-Anderson fracture type, Orthopaedic Trauma Association Open Fracture classification, and limb salvage index score are associated with a poor prognosis, including high risk of infection, nonunion, and amputation [1][2][3] . With improvements in surgical techniques and protocol-driven traumatic lower extremity management at tertiary care centers, limb salvage rates have significantly increased, reaching up to 90% in some reports [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

Review of soft tissue coverage options in distraction osteogenesis of the extremity

Stoneburner¹,

Azadgoli²,

Howell³

et al. 2020

PAR

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Aim: To review the choices of soft tissue coverage in distraction osteogenesis of the extremity. Methods: A PubMed literature search yielded 14 articles included for systematic review. Data were extracted from each article if available (sample size, patient age, surgical indications, type of flap, use of additional modalities, method of bone osteogenesis, postoperative events, follow-up, satisfaction, weight-bearing status, and success rate). Unpaired t-tests were performed to compare complication rates. A retrospective review of three cases was also conducted. Results: Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average. Indications included chronic osteomyelitis or nonunion (58.2%) and acute trauma (41.8%). Average time from injury was 1.1 years. Ilizarov frame was used in 12 articles. Free flaps (88.0%) or rotational flaps (12.0%) were used, with muscle flaps (96.7%) being most common. Most extremities received free latissimus dorsi or rectus abdominis flaps. Bone grafts and antibiotic beads were often used in conjunction. Although complications and reoperations were not uncommon (up to 30%), 98.8% of patients on average were ultimately weight bearing and all articles reported > 91% success rate. Additionally, the rates of any complication were not statistically different between "fix and flap" protocol and flap or frame first. Lastly, a three-patient case series is presented. Conclusion: Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting. Not one surgical approach to limb salvage is superior, and decision should be made on a case by case basis between the surgeon and the patient.

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Analysis of 511 Open Fractures

Cited by 82 publications

References 0 publications

Fatores preditivos de infecção em pacientes com fraturas expostas nos membros inferiores

Fatores preditivos de infecção em pacientes com fraturas expostas nos membros inferiores

Antibiotic Prophylaxis in Open and Closed Fractures:A Controlled Clinical Trial

Review of soft tissue coverage options in distraction osteogenesis of the extremity

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