Infection After Open Long Bone Fractures: Can We Improve on Prophylaxis?

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Abstract

[Indexed for MEDLINE] 11. Br Med Bull. 2021 Sep 10;139(1):48-58. doi: 10.1093/bmb/ldab013. Management of Gustilo-Anderson IIIB open tibial fractures in adults-a systematic review. Myatt A(1), Saleeb H(2), Robertson GAJ(3), Bourhill JK(4), Page PRJ(5), Wood AM(5). Author information: (1)Department of Trauma & Orthopaedics, ST4 Orthopaedic Registrar Leeds General Infirmary MRCSEd, Great George St, Leeds LS1 3EX, UK. (2)Department of Trauma & Orthopaedics, Orthopaedic Registrar Oxford University Hospital MRCS, Headley Way, Headington, Oxford OX3 9DU, UK. (3)Department of Trauma & Orthopaedics, Orthopaedic Registrar Royal Infirmary of Edinburgh FRCSEd (T&O), 51 Little France Cres, Old Dalkeith Rd, Edinburgh EH16 4SA, UK. (4)Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford OX3 9DU, UK. (5)Department of Trauma & Orthopaedics, Trauma Fellow, John Radcliffe Hospital Oxford, FRCS(T&O), Headley Way, Headington, Oxford OX3 9DU, UK. INTRODUCTION: Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons. SOURCES OF DATA: We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures. AREAS OF AGREEMENT AND CONTROVERSY: Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. GROWING POINTS: It is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage. AREAS TIMELY FOR DEVELOPING RESEARCH: A national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes. © Crown copyright 2021. DOI: 10.1093/bmb/ldab013