Recomendaciones en el manejo de las fracturas expuestas

Abstract

Introduction: Open fractures are injuries associated with high morbidity and mortality and is considered an emergency in orthopedic service. An optimal and fast management can affect the prognosis.

Objective: Identify risk factors in an open fracture related to the characteristics and their mechanism of injury. Determinate the time take for the management of the pathology. Describe the antibiotic regimens and surgical treatment applied and to determine the main isolated infectious pathogens.

Methods: This is a descriptive, observational and cross-sectional study. The patients selected are those who got an open fracture between january 2017 to March 2019. The data was collected from digital medical record GEMA used in Hospital Vozandes Quito. They were processed through SPSS statistical program.

Results: 56 patients with open fractures were reviewed. 69.6% were men and 30.4% women. Hand fractures constituted 21.4%, tibia and foot (11% each). Gustilo grade II fracture was 53.6%. Cefazolin and Gentamicin were used in 51% and 48.2% respectively. A multidisciplinary team worked in 35.7% of the cases. Osteosynthesis was performed in the first surgical debridement in 87.5%, where the open reduction was made with internal fixation in 58.9% of the cases. The times of surgical procedures and the days of hospitalization increased according to the Grade of Gustilo classification. The management time for performing the first surgical debridement since the arriving to the emergency room was 6.55 hours (SD 3.63). Five microbial cultures were positive. Those results were considered as a colonization in 4.3% and infected in 6.5%. Non-infectious complications were seen in 10.9% and there were no complications in 78.3% of the patients. The administration of antibiotics started 1,4 hours since the arrival to the hospital (SD1.93).

Conclusions: The optimal and quick control of factors such as the beginning of antibiotics administration, the multidisciplinary management, a good debridement surgery, a fast coverage of the wound and a definitive fixation of the fracture, had an important impact on the days of hospitalization, a reduced amounts of complications in the open fractures studied sample.