Abstract
Management of lower limb open fractures: An unresolved challenge
Highlights
Management of lower limb open fractures is one of the major orthopaedic challenges still subjected to many arguments
Cochrane group study which declared a reduction of infection rate from 13% to 5% in a comparison of prophylactic antibiotics vs placebos in the management of open fractures [7]
The BAPRAS/BOA recommendations have stressed the value of early administration of antibiotics and the importance of administration them within the first 3 hours [5]
Summary
Management of lower limb open fractures is one of the major orthopaedic challenges still subjected to many arguments. Many decades back Gustilo and Anderson in their landmark study expressed clearly the increased risk of infection with the increase in severity of the fracture. Factors leading to infections include incomplete excision of poorly vascularised tissue, inadequate haemostasis and haematoma evacuation, insufficient drainage of wound discharges, devascularization of primarily viable tissue, large metallic fixation devices implanted under poorly vascularised tissue, wound closure under tension and failure to recognize compartment syndrome [4]. Many of these factors can be avoided by following a standard management procedure in handling open fractures. As the first debridement is the most important prognostic factor of open fractures the knowledge on proper handling of lower limb open fracture is an important topic for General surgery as well
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