Open fracture repair: wound infection, implant selection and evaluation of prognosis

doi:10.3969/j.issn.2095-4344.2015.26.030

Abstract

Abstract:

BACKGROUND: Open fractures often present soft-tissue defects, high-risk infection, and fracture with bone defect, often lead to more postoperative complication, defect of limb function, and bring great difficulties to clinical treatment. There is some controversy in the treatment of such fracture. Relevant animal experiment and clinical study become the hotspot in recent years.
OBJECTIVE: To review some controversy about open fracture treatment and latest research.
METHODS: A computer-based online search of China National Knowledge Infrastructure database and PubMed was performed for articles published from January 2005 to January 2015. Key words included “Open fracture, Evaluation and prognosis of injury, Antibiotics, Debirdement, Treatment of fracture, Wound repair”. More than 100 literatures were retrieved, and 47 articles met the inclusion criteria.
RESULTS AND CONCLUSION: After a large number of animal experiments and clinical application, open fracture debridement, prevention of infection, implant selection and evaluation of prognosis had been deeply studied, especially the study of implant treatment of bone defects. Metal three-dimensional printer has changed the traditional concept of implant. Nano titanium dioxide /PEEK bioactive composite materials have become a hot research in recent years.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Fractures, Open, Prostheses and Implants, Debridement

CLC Number:

R318

Ma Xiang-yu, Wang Dong. Open fracture repair: wound infection, implant selection and evaluation of prognosis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(26): 4258-4264.

Figures/Tables 3

References

[1] Sexton SE. Open fractures of the foot and ankle. Clin Podiatr Med Surg.2014;31(4):461-486.
[2] Ali AM,Noyes D,Cogeswell LK.Manggement of open fractures of the lower limb. Br J Hosp Med(Lond). 2013;74(10):577-580.
[3] Gustilo RB,Anderson JT.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. 1976;58(4):453-458.
[4] Gustilo RB,Mendoza RM.Williams DN.Problems in the management of type Ⅲ (severe) open fractures:a new classification of type Ⅲ open fracture. J Trauma. 1984; 24(8):742-746.
[5] Bowen TR,Widmaier JC.Host classification predicts infection after open fracture. Clin Orthop Relat Res.2005;433:205-211.
[6] Agel J,Rockwood T,Barber R,et al.Potential predictive ability of the orthopaedic trauma association open fracture classification.J Orthop Trauma. 2014;28(5):300-306.
[7] Rajasekaran S,Sabapathy SR.A philosophy of care of open injuries based on the Ganga hospital score.Injury. 2007; 38(2):137-146.
[8] Gosselin RA,Roberts I,Gillespie WJ.Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004;1:CD003764.
[9] Zalavras CG,Marcus RE.Levin LS,et al.Management of open fractures and subsequent complications.J Bone Joint Surg Am. 2007;89(4):884-895.
[10] Nanchahal J,Nayagam S,Khan U,et al.Standards for the management of open fractures of the lower limb. London:Royal Society of Medicine Press, 2012:8-10.
[11] Chen AF,Schreiber VM,Washington W,et al.What is the rate of methicillin-resistant staphylococcus aureus and Gram-negative infections in open fracture? Clin Orthop Relat Res. 2013;471(10): 3135-3140.
[12] Saveli CC,Morgan SJ,Belknap RW,et al.Prophyactic antibiotics in open fractures:a pilot randomized clinical safety study. J Orthop Trauma. 2013;27(10):552-557.
[13] Baliga SD,Bose A,Jain S.The evaluation of efficacy of post-operative antibioticsin theopen reduction of the zygomatic and mandibular fracture:a prospective trial. J Maxillofac Oral Surg. 2014;13(2):165-175.
[14] Fletcher N,Sofianos D,Berkes MB,et al.Prevention of perioperative infection. J Bone Joint Surg Am.2007; 89(7): 1605-1618.
[15] Collinge CA,McWilliam-Ross K,Kelly KC,et al.Substantial improvement in prophylactic antibiotic administration for open fracture patients:results of a performance improvement program. J Orthop Trauma. 2014;28(11):620-625.
[16] Ruedi TP,Buckley RE,Moran CG.AO principles of fracture management. 2nd ed, Stuttgart, New York: Thieme, 2007: 322.
[17] Okike K,Bhattacharyya T.Trends in the management of open fraetures.A critical analysis.J Bone Joint Stag Am. 2006;88 (12): 2739-2748.
[18] Penn-Barwell JG,Murray CK,Wenke JC.Local antibiotic delivery by a bioabsorbable gel is superior to PMMA bead depot in reducing infection in an open fracture model. J Orthop Trauma. 2014;28(6):370-375.
[19] Ostermann PA,Seligson D,Henry SL.Local antibiotic therapy for severe open fracture. A review of 1085 consecutive cases. J Bone Surg Br. 1995;77(1):93-97.
[20] Murray CK, Obremskey WT, Hsu JR, et al. Prevention of infections associated with combat-related extremity injuries. J Trauma. 2011;71(2):235-257.
[21] 韩奎敬,夏天,杨述华.盐酸环丙沙星聚乳酸-羟基乙酸共聚物缓释微球在Gustilo型开放性骨折一期内固定辅助治疗中的应用[J].中华实验外科杂志,2011,28(7):1093-1095.
[22] Joyce C,Thomas F,Michelle J,et al.Systematic review and mate-analysis of the additional benefit of local prophylactic antibiotic therapy for infection rates in open tibia fractures treated with intramedullary nailing. Int Orthop. 2014;38(5): 1025-1030.
[23] Dslijit S,Rajnish G, Bassi JL,et al.Open grade3 fractures of tibia outcome after early undreamed intrsmedullary nailing. Eur J Orthop Surg. 2011;21(5):321-325.
[24] Penn-Barwell JG,Rand BC,Brown KV,et al.A versatile model of open-fracture infection:a contaminated segmental rat femur defect. Bone Joint Res. 2014;3(6):187-192.
[25] Kindsfater K,Jonassen EA.Osteomyelitis in grade Ⅱ and Ⅲ open tibia fractures with late debridement. J Orthop Trauma. 1995;9(2):121-127.
[26] Ryan SP, Pugliano V. Controversies in Initial Management of Open Fractures. Scand J Surg. 2014;103(2):132-137.
[27] Al-Arabi YB,Nader M,Hamidian-Jahromi AR.The effect of the tining of antibiotics and surgical treatment on infection rates in open long-bone fractures:a 9-year prospective study from a district general hospital. Injury. 2007;38(8):900-905.
[28] Weber D, Dulai SK,Bergman J,et al.Time to initial operative treatment following open fracture dose not impact development of deep infection:a prospective cohort study of 736 subjects.J Orthop Trauma. 2014;2014,28(11):613-619.
[29] 胥少汀,葛宝丰.实用骨科学[M].北京:人民军医出版社, 2012: 479-483.
[30] Anglen JO.Wound irrigation in musculoskeletal injury.J Am Acad Orthop Surg. 2001;9(4):219-226.
[31] Keating JF,O’Brien PJ,Blachut PA,et al.Locking intramedullary nailing with and without reaming for open fracture of the tibial shaft.A prospective,randomized study. J Bone Joint Surg Am. 1997;79(3):334-341.
[32] Blachut PA,Meek RN,O’Brien PJ,et al.External fixtion and delayed intramedullary nailing of open fractures of the tibial shaft.A sequential protocol. J Bone Joint Surg. 1990;72(5): 729-735.
[33] Esan O,Ikem IC,Oginni LM,et al.Comparison of undreamed interlocking nail and external fixation in open fracture management.West Afr J Med. 2014;33(1):16-20.
[34] Nanchahal J,Nayagam S,Khan U,et al.Standards for management of open fractures of the lower limb. London:Royal Society of Medicine Press, 2012: 30-35.
[35] Aslan A,Uysal E,Ozmeric A.A staged surgical treatment of type 3 open tibial fracture. ISRN Orthop, 2014:721041.
[36] Ozbolat IT, Yu Y. Bioprinting toward organ fabrication: challenges and future trends. IEEE Trans Biomed Eng. 2013; 60(3):22-27.
[37] Wu X,Liu X.Nano-Tio2/PEEK bioactive composite as a bone substitute material:in vitro and in vivo studies. Int J Nanomed. 2012;7:1215-1225.
[38] Mason LW,Wilson-Jones N,Williams P. The use of cell-free chondroinductive implant in a child with massive cartilage loss of the talus after an open fracture dislocation of the ankle:a case report.J Pediatr Orthop.2014;34(8):58-62.
[39] 齐峥嵘,张强,殷毅,等.可降解镁合金作为股植入材料的体内研究进展[J].中国修复重建外科杂志,2012,26(11):1381-1386.
[40] Garg K,Ward CL,Hurgen BJ,et al.Volumetric muscle loss:persistent functional deficits beyond frank loss tissue. J Orthop Res. 2015;33(1):40-46.
[41] Ostermann PA,Henry SL,Seligson D.Timing of wound closure in sevrer compound fractures. Orthopedics. 1994;17(5): 397-399.
[42] Franken JM,Hupkens P.The treatment of soft-tissue defects of the lower leg after a traumatic open tibial fracture. Eur J Plast Surg. 2010;33(3):129-133.
[43] Rajasekaran S,Subbiah M.Direct repair of lumbar spondylolyisis by Buck’s technique. Indian J Orthop. 2011; 45(2):136-140.
[44] 裘华德.负压封闭引流技术[M].北京:人民卫生出版社,2003: 85-242.
[45] 赵敏,周江军,吕仁发,等.一期内固定联合负压封闭引流治疗严重软组织缺损的下肢开放性骨折[J].中国矫形外科杂志,2011, 19(22):1879-1882.
[46] Blun ML,Esser M,Richardson M.Negative pressure wound therapy reduces deep in open tibial fractures.J Orthop Trauma. 2012;26(9):499-505.
[47] Alet JM,Weiget R,Castede JC,et al.Management of traumatic soft tissue defects with dermal regeneration template:a prospective study. Injury. 2014;45(7):1042-1048.