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. 2024 May 3;7(3 Suppl):e313.
doi: 10.1097/OI9.0000000000000313. eCollection 2024 May.

Open fractures: evidence-based best practices

Paul S Whiting  1 , William Obremskey  2 , Herman Johal  3 , David Shearer  4 , David Volgas  5 , Zsolt J Balogh  6   7   8
Affiliations

Open fractures: evidence-based best practices

Paul S Whiting et al. OTA Int. .

Abstract

Open fracture management is a common challenge to orthopaedic trauma surgeons and a burdensome condition to the patient, health care, and entire society. Fracture-related infection (FRI) is the leading morbid complication to avoid during open fracture management because it leads to sepsis, nonunion, limb loss, and overall very poor region-specific and general functional outcomes. This review, based on a symposium presented at the 2022 OTA International Trauma Care Forum, provides a practical and evidence-based summary on key strategies to prevent FRI in open fractures, which can be grouped as optimizing host factors, antimicrobial prophylaxis, surgical site management (skin preparation, debridement, and wound irrigation), provision of skeletal stability, and soft-tissue coverage. When it is applicable, strategies are differentiated between optimal resource and resource-limited settings.

Keywords: antibiotic prophylaxis; fracture; fracture fixation; fracture-related infection; infection; irrigation and debridement; open fracture; soft-tissue coverage; soft-tissue defect; tibia fracture.

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Conflict of interest statement

The authors attest that they have no conflicts of interest in regards to this review, and there was no funding for this study.

References

    1. Metsemakers WJ, Morgenstern M, McNally MA, et al. . Fracture-related infection: a consensus on definition from an international expert group. Injury. 2018;49:505–510. - PubMed
    1. Bowen TR, Widmaier JC. Host classification predicts infection after open fracture. Clin Orthop Relat Res. 2005;433:205–211. - PubMed
    1. Scolaro JA, Schenker ML, Yannascoli S, et al. . Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg. 2014;96:674–681. - PubMed
    1. WHO. Global Guidelines for the Prevention of Surgical Site Infection. Geneva, Switzerland: World Health Organization; 2016:63–67. - PubMed
    1. OʼToole RV, Joshi M, Carlini AR, et al. ; METRC. Local antibiotic therapy to reduce infection after operative treatment of fractures at high risk of infection: a multicenter, randomized, controlled trial (VANCO Study). J Orthop Trauma. 2017;31(suppl 1):S18–S24. - PubMed

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