Timing of Antibiotic and Wound Debridement: Does it Matters in Open Fractures of Long Bones.

Volume 7 | Issue 2 | May – August 2019 | Page: 11- 16 | Monappa Naik A, Raviteja Jampani, Mahesh Suresh Kulkarni, Sandeep Vijayan, Sourabh Shetty, Sharath K Rao, Nirish Reddy


Authors: Monappa Naik A [1], Raviteja Singasani [1], Mahesh Suresh Kulkarni* [1], Sandeep Vijayan [1], Sourabh Shetty [1], Sharath K Rao [1], Nirish Reddy [1].

[1] Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka 576104, India.

Address of Correspondence
Dr. Mahesh Suresh Kulkarni*,
Department of Orthopaedics, Kasturba Medical College,
Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka 576104, India.
E-mail: maheshskulkarnibmc@gmail.com


Abstract

Background: Open fractures are known to have a multitude of complications. In general, open fractures have been considered as a surgical emergency and treated accordingly with emergency debridement and fixation. Previous animal studies emphasized the need for early debridement and antibiotic administration. However, similar results are not observed and translated in the clinical setting. Hence, we designed an observational study in which our aim was to evaluate the factors which determine union and infections following open long-bone fractures.
Materials and Methods: This is a retro prospective study conducted in a tertiary care hospital from 2015 to 2017. All the open fractures of long bones presented to the casualty not later than 48 h of the injury who were skeletally mature included in the study after obtaining informed consent. All the patients who were presented with the open long-bone injuries were treated as per the institution protocol. Patients were followed up regularly and evaluated.
Results: 59 patients with 69 open fractures were considered for the analysis. Type IIIB and C open fractures were significantly more common in lower-limb injuries. There was no significant difference found between the mean age, gender, involved limb, affected side, presence of the comorbidities, mean time between the injury and the presentation, mean time between injury, and the start of the antibiotics between infected/non-infected and united/non-united open fractures. High-grade injuries took significantly higher number of procedures and time to achieve wound closure. Furthermore, cases with infection and non-union have taken significantly more number of procedures to achieve wound closure. An associated bone loss had a significant increase in the infection, bone grafting, and non-union.
Conclusion: In our study, we noted that open fracture severity and bone loss are the main factors which determine the chances of culture-proven infection. Early antibiotics and wound debridement will not necessarily translate into a decrease in infection rates and non-union.
Keywords: Open fractures, non-union, osteomyelitis, infection, long-bone fractures, bone grafting, soft-tissue injuries.


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How to Cite this article: Naik M A, Singasani R, Kulkarni M S*, Vijayan S, Shetty S, Rao S K, Reddy N. Timing of Antibiotic and Wound Debridement: Does it Matters in Open Fractures of Long. Journal of Karnataka Orthopaedic Association May – Aug 2019 ; 7(2): 11-16.

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