Orthopedic wounds

Abstract

Whether a fracture will heal without complications depends, to a significant extent, on the condition of the soft tissues surrounding the bone. Among others, fractures can be classified according to degree of soft tissue involvement, thus facilitating the development of management protocols. Traumatic, open fractures are usually contaminated on arrival at the hospital, whereas contamination of incisional orthopedic wounds can occur in the hospital environment. Our studies have shown that the culture results of incisional wounds correlate most often with results obtained when sampling the air above the wound or the nose and skin of the patient. In addition, failure to excise the traumatized tissue after elective surgery often results in wound-healing complications and infection. If primary closure of the wound is not possible, external fixation to immobilize the fracture and meticulous sterile techniques, wound inspection, and debridement may prevent some, but not all, complications related to the healing of fractures. In addition to application of cancellous bone grafts, we have found that using hydrocolloid dressings facilitates granulation tissue formation. Also, the use of these dressings solves many of the practical problems associated with the traditional methods of keeping the metal plates, exposed bone, and tissues moist. Permanent coverage by means of grafting can be considered at a later date, if delayed primary closure is not possible.