Thursday, February 14, 2002
Managing patients with open fractures
Researchers recently surveyed trauma surgeons about their
treatment of open fractures and reported the results
in poster exhibit 430. A survey was sent to 397 members
of the Orthopedic Trauma Association (OTA).
Questions covered surgeon demographics and
their methods of treatment including culturing wounds,
antibiotic use and duration, frequency of debridements,
and use of oral antibiotics at discharge.
Demographics of the participating surgeons
showed that of the 188 (47%) physicians returning surveys,
60% completed trauma fellowships, 63% had practices with
more than 50% trauma, and 90% reported that
less than 25% of cases were open fractures.
Methods of treatment include:
Researchers say they found two surprising facts through
the survey: there were 17% cultured open wounds
on initial presentation and 14% of physicians discharged
patients with oral antibiotics. A current prospective,
randomized multicenter study is being developed to provide better
guidelines for the management of these patients.
- Culturing wounds: 17 % reported
culturing wounds on admission; 97% used cephalosporins,
77% used aminoglycosides and only 40% used penicillin.
- Antibiotic use and duration: 98% gave
antibiotics after the initial irrigation and
debridement. Of these, 33% gave antibiotics for
24 hours or less while 42% maintained them for 48
hours. Eighty-four percent continued the
same antibiotics after
each irrigation and debridement.
- Frequency of debridements: 74% of grade
I injuries were debrided only once. For grade II injuries,
28% were debrided once, 45% had two. In grade 3A injuries,
39% were debrided once, 37% had a total of 2 irrigation
and debridement. For grades 3B and 3C injuries,
more than 50% of surgeons wrote that
debridements depended upon the wound.
- Use of oral antibiotics at discharge: 14% sent
patients home on oral antibiotics. Although 97% of the OTA
members used cephalosporins, 60% never used penicillin.
- Re-operation: There was no majority for how
many times or how frequently open fractures
were returned to the operating room.
Co-authors of the study include Dolfi Herscovici,
Jr, DO, Julia M. Scaduto,
ARNP, and Roy W. Sanders, MD, all of Tampa, Fla.
Last modified 15/February/2002 by IS