Open extremity fractures

Malhotra, Ajai K.; Goldberg, Solomon C.; Graham, Jeffery; Malhotra, Nancy R.; Willis, Mark C.; Mounasamy, Varatharaj; Guilford, Kelly; Duane, Therèse M.; Aboutanos, Michel B.; Mayglothling, Julie; Ivatury, Rao R.

doi:10.1097/ta.0000000000000205

Cited by 96 publications

(22 citation statements)

References 20 publications

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“…A total of 27 studies described different fracture localizations (two RCTs, seven prospective and 18 retrospective studies, 6,425 fractures) [21,22,25,28,29,32,. Four only defined "upper" and "lower" extremity [21,25,42,61], but the rest actually mentioned two or more specific bones. First, upper extremity fractures were compared to lower extremity fractures [21,22,28,29,32,[41][42][43][44][45][46][47][48][49][50][51][52][53].…”

Section: Fracture Localizationmentioning

confidence: 99%

Risk factors for infectious complications after open fractures; a systematic review and meta-analysis

Kortram

Bezstarosti

Metsemakers

et al. 2017

International Orthopaedics (SICOT)

116

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Section: Fracture Localizationmentioning

confidence: 99%

Risk factors for infectious complications after open fractures; a systematic review and meta-analysis

Kortram

Bezstarosti

Metsemakers

et al. 2017

International Orthopaedics (SICOT)

116

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“…Infection can present acutely in the first few weeks after internal fixation, in a delayed manner with low-grade infection or late with infected non-union or persistent infection after fracture healing [1–3]. The incidence of deep infection after surgical fracture care is relatively high (between 1 and 19%) [4–6], depending on trauma-related risk factors such as contaminated open fractures, damage control procedures and concomitant soft tissue injuries. Early treatment of an acute infection can prevent progression to established PTO but this condition still affects 2–4% of all patients undergoing an open reduction and internal fixation of an open or closed fracture [7].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis – a systematic review of the recent literature

Govaert

IJpma

McNally

et al. 2017

Eur J Nucl Med Mol Imaging

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AimsPost-traumatic osteomyelitis (PTO) is difficult to diagnose and there is no consensus on the best imaging strategy. The aim of this study is to present a systematic review of the recent literature on diagnostic imaging of PTO.MethodsA literature search of the EMBASE and PubMed databases of the last 16 years (2000–2016) was performed. Studies that evaluated the accuracy of magnetic resonance imaging (MRI), three-phase bone scintigraphy (TPBS), white blood cell (WBC) or antigranulocyte antibody (AGA) scintigraphy, fluorodeoxyglucose positron emission tomography (FDG-PET) and plain computed tomography (CT) in diagnosing PTO were considered for inclusion. The review was conducted using the PRISMA statement and QUADAS-2 criteria.ResultsThe literature search identified 3358 original records, of which 10 articles could be included in this review. Four of these studies had a comparative design which made it possible to report the results of, in total, 17 patient series. WBC (or AGA) scintigraphy and FDG-PET exhibit good accuracy for diagnosing PTO (sensitivity ranged from 50–100%, specificity ranged from 40–97% versus 83–100% and 51%–100%, respectively). The accuracy of both modalities improved when a hybrid imaging technique (SPECT/CT & FDG-PET/CT) was performed. For FDG-PET/CT, sensitivity ranged between 86 and 94% and specificity between 76 and 100%. For WBC scintigraphy + SPECT/CT, this is 100% and 89–97%, respectively.ConclusionsBased on the best available evidence of the last 16 years, both WBC (or AGA) scintigraphy combined with SPECT/CT or FDG-PET combined with CT have the best diagnostic accuracy for diagnosing peripheral PTO.

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“…Open lower extremity fractures have a greater likelihood of infection, which makes early soft tissue coverage within hours to days desirable. Vascular damage and neurological damage ought to be treated urgently [ 28 , 29 ]. Furthermore, soft tissue damage especially in the case of multiple non-contiguous fractures often requires serial operations [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Differentiation in an inclusive trauma system: allocation of lower extremity fractures

et al. 2018

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BackgroundImplementation of an inclusive trauma system leads to reduced mortality rates, specifically in polytrauma patients. Field triage is essential in this mortality reduction. Triage systems are developed to identify patients with life-threatening injuries, and trauma mechanisms are important for triaging. Although complex extremity fractures are mostly non-lethal, these injuries are frequently the result of a high-energy trauma mechanism. The aim of this study is to compare injury and patient characteristics, as well as resource demands, of lower extremity fractures between a level (L)1 and level (L)2 trauma centre in a mature inclusive trauma system.MethodsThis is a retrospective cohort study. Patients with below-the-knee joint fractures diagnosed in a L1 or L2 trauma centre between July 2013 and June 2015 were included. Main outcome parameters were patient demographics, trauma mechanism, fracture pattern, and resource demands.ResultsOne thousand two hundred sixty-seven patients with 1517 lower extremity fractures were included. Most patients were treated in the L2 centre (L1 = 417; L2 = 859). Complex fractures were more frequently triaged to the L1 centre. Patients in the L1 centre had more concomitant injuries to other body regions and ipsi- or contralateral lower extremity. Patients in the L1 centre were more resource demanding: more surgeries (> 1 surgery; 24.9% L1 vs 1.4% L2), higher immediate admission rates (70.1% L1 vs 37.6% L2), and longer length of stay (mean 13.4 days L1 vs 3.1 days L2).ConclusionThe majority of patients were treated in the L2 trauma centre, whereas complex lower extremity injuries were mostly treated in the L1 centre, which placed higher demand on resources and labour per patient. This change in allocation is the next step in centralization of low-volume high complex care and high-volume low complex care.

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Open extremity fractures

Abstract: Therapeutic study, level IV.

Cited by 96 publications

References 20 publications

Risk factors for infectious complications after open fractures; a systematic review and meta-analysis

Risk factors for infectious complications after open fractures; a systematic review and meta-analysis

Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis – a systematic review of the recent literature

Differentiation in an inclusive trauma system: allocation of lower extremity fractures

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