Perioperative management of open fractures in the lower limb

Loh, Bryan Lc; Lim, Jiang An; Seah, Matthew; Khan, Wasim

doi:10.1177/17504589211012150

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…Hemostasis should be performed with care because blood loss can be marked, and clots can form a dead space. In suspicion of compartment syndrome, fasciotomy should be performed (1,2,4,12).…”

Section: Imaging Assessmentmentioning

confidence: 99%

Panoramic Review of Open Fractures, Description, Epidemiology, Assessment, Classification, Treatment and Complications

Bryam Esteban Coello García,

Miguel Sebastián Jiménez Jiménez,

Víctor Daniel Camacho Iza

et al. 2023

EPRA

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Introduction: An open or exposed fracture is a fracture that has communication with the external environment through a skin wound. Usually these types of severe fractures require treatment by the orthopedic and plastic surgery team to address both bone and soft tissue injuries. Objective: to detail current information related to open fractures, description, epidemiology, evaluation, classification, treatment and complications. Methodology: a total of 33 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: exposed fractures, open fractures, acute trauma, compartment syndrome, vascular injury, debridement. Results: the general average age of onset is 45.5 years, the incidence decreases in men and increases in women with age. Automobile accidents are the most common cause of open fractures of the lower limbs, accounting for approximately 34.1% of these injuries. The highest incidence of open fractures in males is between 15 and 19 years, the highest incidence in females is between 80 and 89 years. Conclusions: Knowledge of the management of open fractures is of vital importance, due to the fact that this type of fracture presents a high risk of infections, as well as other types of complications. The initial approach to the injured individual with an open fracture should be based on the principles of Advanced Trauma Life Support (ATLS). Clinical and imaging evaluation is important in this type of fracture, as well as recognizing the value of the classification systems that play a critical role when treating surgically. Irrigation and debridement remain the gold standards for proper wound management. The most important point in the treatment of an open fracture is proper lavage and debridement. KEY WORDS: trauma, open fractures, bone exposure, treatment.

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Section: Imaging Assessmentmentioning

confidence: 99%

Panoramic Review of Open Fractures, Description, Epidemiology, Assessment, Classification, Treatment and Complications

Bryam Esteban Coello García,

Miguel Sebastián Jiménez Jiménez,

Víctor Daniel Camacho Iza

et al. 2023

EPRA

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“…Therefore, in addition to limb fracture surgical treatment, appropriate nursing intervention measures that can reduce the pain, alleviate the negative mood, and promote the rehabilitation of patients are also important. Traditional Chinese medicine nursing hot compress (7), comprehensive nursing intervention (8), psychological nursing intervention, pain nursing, and progressive muscle relaxation training of patients with limb fracture can significantly reduce their pain and strengthen the treatment effect (9). Health education can equip patients with diseaserelated knowledge and boost their selfmanagement level.…”

Section: Introductionmentioning

confidence: 99%

Impact of the Interaction Model of Client Health Behavior on the Physical and Psychological Health of Patients with Limb Fracture

Wei¹

2022

ijph

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Background: During rehabilitation, patients with limb fracture should receive physical and psychological nursing. The study aimed to explore the intervention effect of the Interaction Model of Client Health Behavior on the physical and psychological health of patients with limb fracture. Methods: Convenience sampling was used to recruit patients with limb fracture who underwent orthopedic treatment in three hospitals in Zhejiang Province, China from 2021-2022. In total, 118 volunteers were recruited and randomly divided into intervention (n = 60) and control (n = 58) group. The control group received routine treatment and nursing of limb fracture, whereas the intervention group received nursing intervention under the Interaction Model of Client Health Behavior. The Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Athens Insomnia Scale (AIS), and Visual Analogue Scale (VAS) were used to evaluate the effect of nursing intervention under the Interaction Model of Client Health Behavior. Results: The intervention group had significantly lower SDS, SAS, AIS, and VAS scores than the control group (P < 0.001) and significantly higher differences before and after treatment than the control group (P < 0.001). Conclusion: The Interaction Model of Client Health Behavior can effectively improve the physical and psychological health of patients with limb fracture.

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“…7 After removal of contaminated and nonvital tissue, fracture fixation is performed, and immediate wound closure has to be carried out through the "fix and flap" surgical approach. [3][4][5] Whenever a tension-free closure is not suitable, local or distant flaps should be planned to ensure an optimal coverage. Several options are feasible, depending on dimension and localization of the defect, presence of bones or tendons exposure, and type of osteosynthesis.…”

mentioning

confidence: 99%

“…Early administration of intravenous antibiotics followed by aggressive debridement and irrigation is critical elements of open fractures' care that must be performed within 6 hours after injury 7 . After removal of contaminated and nonvital tissue, fracture fixation is performed, and immediate wound closure has to be carried out through the “fix and flap” surgical approach 3–5 …”

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confidence: 99%

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Immediate Soft Tissue Reconstruction in Lower Limb Traumas Using Propeller Perforator Flaps

Gatto,

Giacomini,

Cavalli

et al. 2023

Ann Plast Surg

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Background Open bone fractures represent a demanding clinical condition that can be life- or limb-threatening. For small- to medium-size soft tissue defects of the lower extremity, propeller perforator flaps are a viable option for reconstruction. We report our experience in Gustilo IIIB open fractures treatment with immediate coverage through propeller-based perforator flaps performed in acute setting. Methods Between 2019 and 2022, 94 Gustilo III fractures were admitted to our trauma center, and 28 were Gustilo IIIB fractures. Five patients were eligible for an immediate perforator-based propeller flaps reconstruction. The mean age of the patients was 33.8 years. All of them were male. One of them was a heavy smoker (15 cigarettes per day). No other comorbidities were present. Results The mean operating time, including fracture reduction and fixation time, was 106 minutes. The length of the defect varied between 5 and 7 cm and the width between 3 and 4 cm. We reported no major complications, and none of the patients required a surgical revision of the flap. A patient with smoking habit reported a superficial flap necrosis. The mean follow-up was 5.5 months. No cases of nonunion or osteomyelitis have developed so far. Conclusions The use of perforator-based propeller flaps, in acute trauma setting, has not been reported in literature so far. In our experience, propeller perforator flaps are a viable reconstructive option in immediate reconstruction during the acute management of open fractures.

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Perioperative management of open fractures in the lower limb

Cited by 6 publications

References 31 publications

Panoramic Review of Open Fractures, Description, Epidemiology, Assessment, Classification, Treatment and Complications

Panoramic Review of Open Fractures, Description, Epidemiology, Assessment, Classification, Treatment and Complications

Impact of the Interaction Model of Client Health Behavior on the Physical and Psychological Health of Patients with Limb Fracture

Immediate Soft Tissue Reconstruction in Lower Limb Traumas Using Propeller Perforator Flaps

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