open fractures

Summary

Summary: Fractures in which there is an external wound communicating with the break of the bone.

Top Publications

  1. Zalavras C, Patzakis M, Holtom P, Sherman R. Management of open fractures. Infect Dis Clin North Am. 2005;19:915-29 pubmed
    b>Open fractures are high-energy injuries that require a principle-based approach, starting with detailed evaluation of patient status and injury severity...
  2. Hauser C, Adams C, Eachempati S. Surgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline. Surg Infect (Larchmt). 2006;7:379-405 pubmed
    ..antibiotics are often cited as the standard of care for prevention of infective complications of open fractures. The origins of these recommendations are obscure, however, and multi-drug-resistant systemic infections ..
  3. Giannoudis P, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br. 2006;88:281-9 pubmed
  4. Barie P. Breaking with tradition: evidence-based antibiotic prophylaxis of open fractures. Surg Infect (Larchmt). 2006;7:327-9 pubmed
  5. Anglen J. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J Bone Joint Surg Am. 2005;87:1415-22 pubmed
    ..This study was performed to compare the efficacy of those two solutions in the treatment of open fractures in humans.
  6. Zalavras C, Marcus R, Levin L, Patzakis M. Management of open fractures and subsequent complications. J Bone Joint Surg Am. 2007;89:884-95 pubmed
  7. Inan M, Halici M, Ayan I, Tuncel M, Karaoglu S. Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing. Arch Orthop Trauma Surg. 2007;127:617-23 pubmed
    The aim of this study was to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov external fixation (IEF) for the treatment of type IIIA open fractures of the tibia.
  8. Crowley D, Kanakaris N, Giannoudis P. Debridement and wound closure of open fractures: the impact of the time factor on infection rates. Injury. 2007;38:879-89 pubmed
    ..This review article analyses the available evidence regarding the impact of the timing of wound debridement and closure of open fractures of the lower extremity.
  9. Rajasekaran S. Early versus delayed closure of open fractures. Injury. 2007;38:890-5 pubmed

More Information

Publications70

  1. Bhandari M, Guyatt G, Tornetta P, Schemitsch E, Swiontkowski M, Sanders D, et al. Study to prospectively evaluate reamed intramedually nails in patients with tibial fractures (S.P.R.I.N.T.): study rationale and design. BMC Musculoskelet Disord. 2008;9:91 pubmed publisher
  2. Petrisor B, Jeray K, Schemitsch E, Hanson B, Sprague S, Sanders D, et al. Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons. BMC Musculoskelet Disord. 2008;9:7 pubmed publisher
    ..Our objective was to clarify current opinion with regard to the irrigation of open fracture wounds...
  3. . Fluid lavage of open wounds (FLOW): design and rationale for a large, multicenter collaborative 2 x 3 factorial trial of irrigating pressures and solutions in patients with open fractures. BMC Musculoskelet Disord. 2010;11:85 pubmed publisher
    b>Open fractures frequently result in serious complications for patients, including infections, wound healing problems, and failure of fracture healing, many of which necessitate subsequent operations...
  4. Koulouvaris P, Stafylas K, Mitsionis G, Vekris M, Mavrodontidis A, Xenakis T. Long-term results of various therapy concepts in severe pilon fractures. Arch Orthop Trauma Surg. 2007;127:313-20 pubmed
    ..This is a retrospective case-control study of surgically treated pilon fractures which was undertaken to compare the internal fixation with the two external fixation methods...
  5. Crowley D, Kanakaris N, Giannoudis P. Irrigation of the wounds in open fractures. J Bone Joint Surg Br. 2007;89:580-5 pubmed
    Modern principles for the treatment of open fractures include stabilisation of the bone and management of the soft tissues. Wound debridement and irrigation is thought to be the mainstay in reducing the incidence of infection...
  6. Levin L. Early versus delayed closure of open fractures. Injury. 2007;38:896-9 pubmed
    Despite convincing data from Ljubljana, Yugoslavia 20 years ago, that emergency free tissue transfer for open fractures results in a low infection rate, shorter hospitalisation, decreased time for bone healing, and low incidence of flap ..
  7. Zalavras C, Marcus R, Levin L, Patzakis M. Management of open fractures and subsequent complications. Instr Course Lect. 2008;57:51-63 pubmed
    Early, systemic, wide-spectrum antibiotic therapy is necessary for the treatment of open fractures. The bead pouch technique delivers antibiotics locally and prevents secondary wound contamination...
  8. Nauth A, Ristiniemi J, McKee M, Schemitsch E. Bone morphogenetic proteins in open fractures: past, present, and future. Injury. 2009;40 Suppl 3:S27-31 pubmed publisher
    The management of open fractures continues to be complicated by high rates of treatment failure and significant patient disability and dissatisfaction...
  9. Li B, Jiang B, Dietz M, Smith E, Clovis N, Rao K. Evaluation of local MCP-1 and IL-12 nanocoatings for infection prevention in open fractures. J Orthop Res. 2010;28:48-54 pubmed publisher
    ..IL-12 p70 deliveries were prepared, and their release characteristics desirable for infection prevention in open fractures were explored. Local MCP-1 therapy reduced S...
  10. Schnirring Judge M, Anderson E. Vessel loop closure technique in open fractures and other complex wounds in the foot and ankle. J Foot Ankle Surg. 2009;48:692-9 pubmed publisher
    ..In this report, we describe the use of a vessel loop, or loops, for reapproximation of the margins of gaping wounds of the foot or ankle...
  11. Kaftandziev I, Pejkova S, Saveski J. Operative treatment of III grade open fractures of the tibial diaphysis. Prilozi. 2006;27:121-31 pubmed
    b>Open fractures, especially III grade open fractures of the tibial diaphysis, according to the Gustilo classification still remains a serious therapeutic problem...
  12. Prasarn M, Zych G, Ostermann P. Wound management for severe open fractures: use of antibiotic bead pouches and vacuum-assisted closure. Am J Orthop (Belle Mead NJ). 2009;38:559-63 pubmed
    b>Open fractures complicated by infection, or those requiring extensive soft-tissue procedures, are disabling problems for patients and result in significant costs for the health care system...
  13. Okike K, Bhattacharyya T. Trends in the management of open fractures. A critical analysis. J Bone Joint Surg Am. 2006;88:2739-48 pubmed
  14. Morgan B, Read J, Solan M. Photographic wound documentation of open fractures: an update for the digital generation. Emerg Med J. 2007;24:841-2 pubmed
    ..To examine the availability of working cameras in UK emergency departments and to discuss the merits of digital imaging over Polaroid...
  15. Gessmann J, Baecker H, Graf M, Ozokyay L, Muhr G, Seybold D. [Operative treatment of pediatric open fractures of the lower limb using the Taylor spatial frame fixator]. Unfallchirurg. 2010;113:413-7 pubmed publisher
    The operative management of open fractures of the lower limb requires a consistent treatment to avoid soft tissue complications...
  16. Noumi T, Yokoyama K, Ohtsuka H, Nakamura K, Itoman M. Intramedullary nailing for open fractures of the femoral shaft: evaluation of contributing factors on deep infection and nonunion using multivariate analysis. Injury. 2005;36:1085-93 pubmed
    ..05). Nonunion occurred in 12 fractures (14.1%). Multivariate analysis revealed that only fracture grade by AO type significantly correlated with occurrence of nonunion (p<0.02)...
  17. Stannard J, Volgas D, Stewart R, McGwin G, Alonso J. Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma. 2009;23:552-7 pubmed publisher
    To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection.
  18. Werner C, Pierpont Y, Pollak A. The urgency of surgical débridement in the management of open fractures. J Am Acad Orthop Surg. 2008;16:369-75 pubmed
    Emergent débridement of open fractures within 6 hours of injury has long been considered to be critical to prevention of infection. The basis for this mandate is unclear, however...
  19. Apivatthakakul T, Sananpanich K. The locking compression plate as an external fixator for bone transport in the treatment of a large distal tibial defect: a case report. Injury. 2007;38:1318-25 pubmed
  20. Gustilo R, Anderson J. JSBS classics. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. Retrospective and prospective analyses. J Bone Joint Surg Am. 2002;84-A:682 pubmed
  21. Russell G, King C, May C, Pearsall A. Once daily high-dose gentamicin to prevent infection in open fractures of the tibial shaft: a preliminary investigation. South Med J. 2001;94:1185-91 pubmed
    ..We evaluated cephalosporin in conjunction with once daily high-dose gentamicin as prophylaxis against infection in Gustilo types II and III open tibial shaft fractures...
  22. Bhandari M, Guyatt G, Tornetta P, Swiontkowski M, Hanson B, Sprague S, et al. Current practice in the intramedullary nailing of tibial shaft fractures: an international survey. J Trauma. 2002;53:725-32 pubmed
    ..many tibial fractures may be managed conservatively, a certain subset, including unstable fractures and open fractures, require operative stabilization...
  23. Worlock P, Slack R, Harvey L, Mawhinney R. The prevention of infection in open fractures. An experimental study of the effect of antibiotic therapy. J Bone Joint Surg Am. 1988;70:1341-7 pubmed
    ..The effect of the antibiotic therefore persisted even when the initial dose was delayed for four hours after bacterial inoculation...
  24. Suprock M, Hood J, Lubahn J. Role of antibiotics in open fractures of the finger. J Hand Surg Am. 1990;15:761-4 pubmed
    The role of antibiotics was investigated prospectively in 91 open fractures of the finger. Antibiotics were administered to alternate patients with open phalangeal fractures...
  25. Harley B, Beaupre L, Jones C, Dulai S, Weber D. The effect of time to definitive treatment on the rate of nonunion and infection in open fractures. J Orthop Trauma. 2002;16:484-90 pubmed
    ..the association between time to definitive surgical management and the rates of nonunion and infection in open fractures resulting from blunt trauma...
  26. Weitz Marshall A, Bosse M. Timing of closure of open fractures. J Am Acad Orthop Surg. 2002;10:379-84 pubmed
    Traditionally, closure of open fractures after initial debridement has been delayed to minimize the risk of complications, particularly infection...
  27. Zalavras C, Patzakis M. Open fractures: evaluation and management. J Am Acad Orthop Surg. 2003;11:212-9 pubmed
    b>Open fractures are complex injuries that involve both the bone and surrounding soft tissues. Management goals are prevention of infection, union of the fracture, and restoration of function...
  28. Shah R, Moehring H, Singh R, Dhakal A. Surgical Implant Generation Network (SIGN) intramedullary nailing of open fractures of the tibia. Int Orthop. 2004;28:163-6 pubmed
    ..Intramedullary nailing, with appropriate soft-tissue treatment, gives good results in the treatment of open tibial fractures...
  29. Spencer J, Smith A, Woods D. The effect of time delay on infection in open long-bone fractures: a 5-year prospective audit from a district general hospital. Ann R Coll Surg Engl. 2004;86:108-12 pubmed
    ..To determine whether a time delay of greater than 6 h from injury to surgical debridement affected the infection rate in open long-bone fractures in a typical district general hospital in the UK...
  30. Skaggs D, Friend L, Alman B, Chambers H, Schmitz M, Leake B, et al. The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am. 2005;87:8-12 pubmed
    Traditional recommendations hold that open fractures in both children and adults require urgent surgical debridement for a number of reasons, including the preservation of soft-tissue viability and vascular status as well as the ..
  31. Castillo R, Bosse M, MacKenzie E, Patterson B. Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma. 2005;19:151-7 pubmed
    ..The present study is the first to prospectively examine time to union, as well as major complications of the fracture healing process, while adjusting for potential confounders...
  32. Malik Z, Hanif M, Safdar A, Masood T. Planned external fixation to locked intramedullary nailing conversion for open fractures of shaft of femur and tibia. J Coll Physicians Surg Pak. 2005;15:133-6 pubmed
    ..To determine the outcome of initial external fixation and then conversion to intramedullary nailing in patients having open fracture of shaft of femur or tibia...
  33. Lee E, Dirschl D, Duff G, Dahners L, Miclau T. High-pressure pulsatile lavage irrigation of fresh intraarticular fractures: effectiveness at removing particulate matter from bone. J Orthop Trauma. 2002;16:162-5 pubmed
    ..To determine the effectiveness of high-pressure pulsatile lavage (HPL) versus bulb syringe (BS) irrigation in removing particulate matter from metaphyseal cancellous bone...
  34. Joshi D, Ahmed A, Krishna L, Lal Y. Unreamed interlocking nailing in open fractures of tibia. J Orthop Surg (Hong Kong). 2004;12:216-21 pubmed
    To assess the clinical outcome of unreamed intramedullary interlocking nailing in open fractures of tibia, and to evaluate the incidence of complications in these open fractures as a result of the unreamed intramedullary nailing.
  35. Harrison W, Lewis C, Lavy C. Open fractures of the tibia in HIV positive patients: a prospective controlled single-blind study. Injury. 2004;35:852-6 pubmed
    Twenty-seven patients with severe open fractures were studied prospectively analysing infection and union as outcome measures. A standard treatment regime was applied. Seven patients were HIV positive, and 20 patients HIV negative...
  36. Bach O, Hope M, Chaheka C, Dzimbiri K. Disability can be avoided after open fractures in Africa-results from Malawi. Injury. 2004;35:846-51 pubmed
    In a free-at source hospital in Malawi, East Africa, 55 open fractures were treated within a 3-year period. The majority (33/55) involved fractures of the lower leg...
  37. Muscolo D, Ayerza M, Aponte Tinao L, Ranalletta M. Distal femur osteoarticular allograft reconstruction after grade III open fractures in pediatric patients. J Orthop Trauma. 2004;18:312-5 pubmed
    ..At 2 and 10 years of follow-up, both patients showed a favorable functional and radiographic outcome using the scoring instruments of the Musculo-skeletal Tumor Society and the International Symposium on Limb Salvage...
  38. Anglen J. Wound irrigation in musculoskeletal injury. J Am Acad Orthop Surg. 2001;9:219-26 pubmed
    ..There are few animal or clinical studies of musculoskeletal wounds. Detergent irrigation aims to remove, rather than kill, bacteria and has shown promise in animal models of the complex contaminated musculoskeletal wound...
  39. Valenziano C, Chattar Cora D, O Neill A, Hubli E, Cudjoe E. Efficacy of primary wound cultures in long bone open extremity fractures: are they of any value?. Arch Orthop Trauma Surg. 2002;122:259-61 pubmed
    ..The use of primary wound cultures in open extremity injuries has no value in the management of patients suffering long bone open extremity fractures...
  40. Alonge T, Salawu S, Adebisi A, Fashina A. The choice of antibiotic in open fractures in a teaching hospital in a developing country. Int J Clin Pract. 2002;56:353-6 pubmed
    ..Before this study, the choice of antibiotic in the management of open fractures in our hospital was based on tradition and 'best guess' antibiotics...
  41. Heier K, Infante A, Walling A, Sanders R. Open fractures of the calcaneus: soft-tissue injury determines outcome. J Bone Joint Surg Am. 2003;85-A:2276-82 pubmed
    ..In this study, results were evaluated on the basis of the hypothesis that early surgical intervention was indicated...
  42. Khatod M, Botte M, Hoyt D, Meyer R, Smith J, Akeson W. Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma. 2003;55:949-54 pubmed
    ..The purpose of this study was to evaluate the infectious outcome of open tibia fractures relative to the time from injury to operative irrigation and debridement...
  43. Hosny G, Fadel M. Ilizarov external fixator for open fractures of the tibial shaft. Int Orthop. 2003;27:303-6 pubmed
    ..6 (3-15.4) months. In 28 patients the results were excellent and good, in one fair and in one poor. Despite numerous complications the use of Ilizarov external fixator provides initial and definitive fracture stability...
  44. Bhandari M, Tornetta P, Sprague S, Najibi S, Petrisor B, Griffith L, et al. Predictors of reoperation following operative management of fractures of the tibial shaft. J Orthop Trauma. 2003;17:353-61 pubmed
    ..Accurate prediction of likelihood of reoperation in patients with tibial shaft fractures would facilitate optimal management. Previous studies were limited by small sample sizes and noncomprehensive examination of possible risk factors...
  45. Bhandari M, Guyatt G, Swiontkowski M, Schemitsch E. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br. 2001;83:62-8 pubmed
    ..The relative merits of reamed versus unreamed nails in the treatment of open tibial fractures remain uncertain...
  46. Obrebski M, Rapała K, Milecki M. [Neer classification of the proximal humerus fractures based on our own material]. Chir Narzadow Ruchu Ortop Pol. 2006;71:43-9 pubmed
    ..When diagnosis was questionable examination had to be broadened by axillar exposure and CT performed in the stated sequence. ..
  47. Rajasekaran S, Sabapathy S. A philosophy of care of open injuries based on the Ganga hospital score. Injury. 2007;38:137-46 pubmed
    ..The score was thus found to be useful clinically not only to assess salvage but also to provide guidelines in reconstruction. ..
  48. Visna P, Beitl E, Smidl Z, Kalvach J, Jaganjac E. [Callus distraction lengthening of the tibia with the intramedullary kinetic nail (case report)]. Acta Chir Orthop Traumatol Cech. 2007;74:287-91 pubmed
    ..At 12 months after surgery, the patient showed a full range of motion in the knee, his ankle range of motion was S 15-0-35, and he achieved an excellent functional outcome on evaluation by Paley's classification. ..
  49. Ferraz L, Juvet Segarra M, Pocquet X, Mertl P, Havet E. Does inter-tibiofibular graft still have a role in the treatment of lower-limb non-union?. Orthop Traumatol Surg Res. 2016;102:223-6 pubmed publisher
    ..Twenty cases involved high-energy trauma. Twenty-four were open fractures. Twenty-two concerned diaphyseal fracture, 10 of which were complex segmental...
  50. El Khatib H. The split peroneus muscle flap: a new flap for lower leg defects. J Plast Reconstr Aesthet Surg. 2007;60:898-903 pubmed
    ..The flap has been tested on seven male patients who had sustained open fractures of the ankle region with metal implant exposure of the fibula...
  51. Witz M, Gepstein R, Paran H, Shnaker A, Lehmann J, Gryton I, et al. Endovascular treatment of an open cervical fracture with carotid artery tear. Eur Spine J. 2006;15 Suppl 5:650-2 pubmed
    ..The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report. ..
  52. Cannada L, Jones T, Guerrero Bejarano M, Viehe T, Levy M, Farrell E, et al. Retrograde intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots. Orthopedics. 2009;32:162 pubmed
    ..This study demonstrates that this is an acceptable alternative for the treatment of these injuries. ..
  53. Soubeyrand M, Vincent Mansour C, Guidon J, Asselineau A, Ducharnes G, Molina V. Severe open ankle sprain (SOAS): a lesion presenting as a penetrating soft tissue injury. J Foot Ankle Surg. 2010;49:253-8 pubmed publisher
    ..22% (9/4142) of all cases of ankle trauma. The diagnosis was confirmed by intraoperative stress-maneuvers in all 9 patients. In conclusion, SOAS should be suspected in patients who present with a traumatic skin wound over the malleolus. ..
  54. Gulsen M, Ozkan C. Angular shortening and delayed gradual distraction for the treatment of asymmetrical bone and soft tissue defects of tibia: a case series. J Trauma. 2009;66:E61-6 pubmed publisher
    Acute shortening is reported to be an effective method for the treatment of open fractures with bone and soft tissue defects...
  55. Ma C, Wu C, Yu S, Yen C, Tu Y. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. Injury. 2010;41:190-6 pubmed publisher
    ..Surgeons were able to achieve gross anatomy restoration, soft-tissue reconstruction, stable fixation and high union rates. Patients obtained good-to-excellent motion, function and comfort after treatment...
  56. Brederlau J, Anetseder M, Schoefinius A, Wurmb T, Muellenbach R, Kredel M, et al. Arteriovenous extracorporeal lung assist and high frequency oscillatory ventilation in post-traumatic acute respiratory distress syndrome. J Trauma. 2008;64:E65-8 pubmed
  57. Brown K, Walker J, Cortez D, Murray C, Wenke J. Earlier debridement and antibiotic administration decrease infection. J Surg Orthop Adv. 2010;19:18-22 pubmed
    ..It was concluded that early debridement in combination with local delivery of antibiotics of contaminated defects may reduce infections...
  58. Lindsey B, Clovis N, Smith E, Salihu S, Hubbard D. An animal model for open femur fracture and osteomyelitis--Part II: Immunomodulation with systemic IL-12. J Orthop Res. 2010;28:43-7 pubmed publisher
  59. Hallock G. Free-flap monitoring using a chimeric sentinel muscle perforator flap. J Reconstr Microsurg. 2005;21:351-4 pubmed
    ..This can be a valuable adjunctive use of muscle perforator flaps for the continuous assessment of free muscle flaps or as an exteriorized flap for the monitoring of buried free flaps...
  60. Ueno M, Yokoyama K, Nakamura K, Uchino M, Suzuki T, Itoman M. Early unreamed intramedullary nailing without a safety interval and simultaneous flap coverage following external fixation in type IIIB open tibial fractures: a report of four successful cases. Injury. 2006;37:289-94 pubmed
    ..The functions in all patients were satisfactory. This early unreamed IMN without a safety interval and with simultaneous flap coverage following EF is a useful and effective option for treating type IIIB open tibial fractures...
  61. Todkar M. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. J Bone Joint Surg Am. 2006;88:452; author reply 452 pubmed