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Case Study
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A novel apoproach to open fracture debridement and wound care Pratik P. Desai, MD, Michael Suk, MD, JD, MPH Current practice in the management of open tibia Gustilo II-IIIa injuries involves emergent debridement and irrigation (D and I) of the wound. Often times, multiple such procedures are necessary prior to discharge. It is a known fact in orthopaedic literature that open fractures have a higher incidence of developing deep infections, progressing to nonunion, and subsequently obviating repeat or additional surgical procedures. Studies have shown that infection rates in these fractures can range from 10-50%, and nonunion rates can climb as high as 76% with open fractures. Meanwhile, others underscore the importance of the soft tissue envelope to fracture healing, and promote early and adequate debridement. Therefore, sufficient and complete debridement of the bone and soft tissue is absolutely necessary.. .It is the purpose of this case series to introduce a novel approach to open fracture debridement, irrigation, and wound care. At a level-one trauma center, open tibia Gustilo II-IIIa fractures are taken for emergent D and I. We use a novel hydrosurgery device* to achieve our soft-tissue and bony debridement. Thereafter, the wound is irrigated and a silver-coated wound dressing** is placed directly on bone prior to wound closure. This dressing is removed and replaced at every subsequent D and I until definitive fixation is performed. Finally an additional dressing is placed on skin for three days postoperatively.. .It is our experience that a novel method of open fracture treatment provides a more comprehensive and efficient debridement, while providing an additional barrier to over 150 microorganisms. We report encouraging early results with this method, as we have encountered no infections. The benefit of reducing infections to bony health has been repeatedly described. Consequently, the potential to reduce operative procedures, infection and nonunion with this method warrants further study *Versajetª, Smith and Nephew Inc., Largo, FL.**Acticoatª, Smith and Nephew Inc., Largo, FL Esterhai JL, Queenan J. Management of soft tissue wounds associated with type III open fractures. Orthop Clin North Am. 1991;22(3):427Ð432 Malik MH, Harwood P, Diggle P, Khan SA. Factors affecting rate of infection and nonunion in intramedullary nailing. JBJS Br. 2004;86(4):556Ð560 Karladani AH, Granhed H, Karrholm J, Styf J. The influence of fracture etiology and type on fracture healing: a review of 104 consecutive tibial shaft fractures. Arch Orthop Trauma Surg. 2001;121(6):325Ð328 Brueckmann FR, Roberts GJ. Complications of open tibial fractures. Indiana Med. 1989;82(9):694Ð698 Green SA, Moore TA, Spohn PJ. Nonunion of the tibial shaft. Orthopaedics. 1988;11(8):1149Ð1157. |
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