Open Fracture Type Research Articles

Infection Rates and Surgical Procedures Associated With Isolated Open Talar Neck and Body Fractures.

Open fractures of the talar body and neck are uncommon. Previous reports of associated deep infection rates and resulting surgical requirements vary widely. The primary objective of this study is to report the incidence of deep infections for isolated open talar body and neck fractures, and secondarily the incidence and number of total surgeries performed (TSP), secondary salvage procedures (SSPs), and nonsalvage procedures (NSPs). Retrospective case-control study of 32 consecutive isolated open talus fracture patients (22 neck, 10 body) were followed for an average of 39.2 months. Five (15.6%) fractures developed deep infections. Fifty percent of open body fractures became infected compared with 0% of neck fractures (P < .001). There was no difference between infected group (IG) and uninfected fracture group (UG) with respect to age, sex, body mass index, tobacco, diabetes, vascular disease, open fracture type, wound location, hours to irrigation and debridement, or definitive treatment. The majority (92.6%) of UG fractures used a dual incision with open wound extension. There were more single extensile approaches in the IG group (P = .04). The IG required 5.8 TSP per patient compared with 2.1 in the UG (P = .004). All (100%) of the IG required an SSP compared with 29.6% of the UG (P = .006). All (100%) of the IG required an NSP compared to 40.7% of the UG (P = .043). In the IG, 2.8 NSPs per patient were required after definitive surgery compared with 1.18 in the UG (P = .003). Of those followed 1 year, the incidence of SSP remained higher in the IG (P = .016). The incidence of deep infection following isolated open talar fractures is high and occurs disproportionally in body fractures. Infected fractures required nearly 6 surgeries, and all required SSP. Level IV, prognostic.

Post-Operative Wound Infection after Treatment of Open Fracture Type II and Type IIIA by Applying Ilizarov Fixator: A Single Centre Experience in Bangladesh

Background: Treatment of open fracture type II and type IIIA is difficult problem as because there is chance of formation of infection (osteomyelitis) and ultimate nonunion of fracture. Objective: The purpose of the present study was to assess the rate of post-operative wound infection by application of Ilizarov fixator among open fracture of tibia in type II and type IIIA. Methodology: This was a non-randomized clinical trial which was conducted in the Department of Orthopedic Surgery at Ad-Din Sakina Women’s Medical College, Jashore, Bangladesh and at different private institutes in that area from January 2017 to December 2022 for a period of six years. The patients with the age group of 20 to 70 years were selected as study population. Results: A total number of 25 patients were recruited for this study. Out of 25 patients, 20 cases were male and 5 cases were female. Out of 25 patients 3 patients were diabetic and 2 patients were hypertensive. Affected side were on both side. The patients were included in this study and obtained excellent result with ilizarov procedure. Success rate was considered almost 100 present. Three patent developed minor wound infection. Conclusion: In conclusion no wound infection is found among the patients presented with open fracture of type II and type IIIA by application of Ilizarov fixator. Bangladesh Journal of Medical Microbiology, July 2023;17(2):60-65

Treatment of Open Femur Fracture of the Gunshot Injuries by Interlocking Nail in Aden, Yemen

Background: Gunshot wounds remain a major clinical problem with bone injuries. Objective: To evaluate the treatment procedures of open fractures due to gunshot and the outcome Patients and methods: This was a prospective study conducted during January 2019 to December 2020. The enrolled patients were males having open fracture of femur due to gunshot or explosive shrapnel injuries and the data collected directly from patients by interview. The fractures were classified according to Gustilo classification. All patients underwent with stainless steel intramedullary nail with proximal and distal screws. Follow up of patients was for six months. Data were processed using the SPSS, version 22. Fisher test was used and p-value &lt; 0.05 was considered as statistically significant. Results: The study cases were 62 male patients. Age ranged between 17 to 50 years and the mean age was 25.7 ± 7.2 years. Gustilo open fracture type 3A seen in (98.4%) patients. Most of the site of femur fracture was at mid shaft (67.8%). Half of patients (53.3%) had time interval of first debridement within 7 – 12 hours, Predominantly debridement was performed once in (82.4%) patients. Mostly, delayed primary closure was carried out within 3 – 7 days in (71%) patients. IM nail was carried out mostly (56.6%) of cases within 7-14 days. We found superficial infection and acute osteomyelitis each one in (6.5%) patients. Pulmonary embolism found in (3.2%) patients. Deep wound infection, chronic osteomyelitis, deep vein thrombosis, each one was in (1.6%) patient. We found shortening in (1.6%) patient, mal-union in (1.6%) patient, non-union in (3.2%) patients and stiffness found in (3.2%) patients. Conclusion: Intramedullary nailing provide an effective device in patients with gunshot fractures of femur and it is safe and provides strong fixation, rotational stability and earliest return to functional status. Keywords: Open femur fracture, gunshot injuries, interlocking nail

The double-plate fixation technique prevents varus collapse in AO type C3 supra-intercondylar fracture of the distal femur

IntroductionVarus collapse followed by osteosynthesis for distal femoral fractures with conventional implants has been well documented but is seldom mentioned in fractures managed with locking plates. The purpose of this study was to assess the incidence of varus collapse after treating complex supra-intercondylar fractures of the distal femur (AO type C3) using a Single Plate (SP) or Double Plate (DP) fixation technique.Materials and methodsWe retrospectively reviewed 357 patients with distal femoral fractures who were treated at our hospital between 2006 and 2017. After excluding cases of infection, malignancy, periprosthetic fracture, revision surgery, pediatric fracture, and extra-articular fracture, 54 patients were included in the study. All demographic data and radiological and clinical outcomes were reviewed and analyzed.ResultsThere were 54 patients enrolled into this study with age from 15 to 85 years old (mean 41.6, SD = 19.9), and 32 of them were open fractures (59%). The patients were further divided into either an SP (n = 15) or a DP group (n = 39). Demographics, including age, sex, injury severity score, and open fracture type, were all compatible between the two groups. The overall nonunion rate was 25.9% (n = 14; 6 from the SP and 8 from the DP group; p = 0.175). The varus collapse rate was 9.3% (n = 5; 4 from the SP and 1 from the DP group (p = 0.018).ConclusionsThe varus collapse rate after osteosynthesis with a single lateral locking plate could be as high as 26.7% in AO type C3 fractures of the distal femur, which would be decreased to 2.6% by adding a medial buttress plate. Surgeons should consider DP fixation to avoid varus collapse in severely comminuted complete intra-articular fractures of the distal femur.

Local administration of vancomycin powder in orthopaedic fracture surgery: current practice and trends.

Surgical site infections in orthopaedic trauma are a significant problem with meaningful patient and health care system-level consequences. Direct application of antibiotics to the surgical field has many potential benefits in reducing surgical site infections. However, to date, the data regarding the local administration of antibiotics have been mixed. This study reports on the variability of prophylactic vancomycin powder use in orthopaedic trauma cases across 28 centers. Intrawound topical antibiotic powder use was prospectively collected within three multicenter fracture fixation trials. Fracture location, Gustilo classification, recruiting center, and surgeon information were collected. Differences in practice patterns across recruiting center and injury characteristics were tested using chi-square statistic and logistic regression. Additional stratified analyses by recruiting center and individual surgeon were performed. A total of 4941 fractures were treated, and vancomycin powder was used in 1547 patients (31%) overall. Local administration of vancomycin powder was more frequent in open fractures 38.8% (738/1901) compared with closed fractures 26.6% (809/3040) (P < 0.001). However, the severity of the open fracture type did not affect the rate at which vancomycin powder was used (P = 0.11). Vancomycin powder use varied substantially across the clinical sites (P < 0.001). At the surgeon level, 75.0% used vancomycin powder in less than one-quarter of their cases. Prophylactic intrawound vancomycin powder remains controversial with varied support throughout the literature. This study demonstrates wide variability in its use across institutions, fracture types, and surgeons. This study highlights the opportunity for increased practice standardization for infection prophylaxis interventions. Prognostic-III.

Evaluation of Radiological and Functional Results of Long Bone Diaphyseal Fractures in Children Aged 5-15 Years Who Underwent Titanium Elastic Nail

Objective: In this study, we aimed to evaluate the radiological and functional results of titanium elastic nail (TEN), which was used as a surgical method in pediatric long bone diaphyseal fractures between 5-15 years of age, by comparing it with the clinical features of the patient and the fracture.Methods: In this study, 44 patients (11 girls, 33 boys) aged 5-15 years (mean 9.86 ±2.84) were included. The clinical features of the patient, family satisfaction, evaluation of the fracture according to Flynn Criteria, time to bone union, stay in the hospital, and school absence was examined.Results: TEN was applied mostly to the femur (n;18), tibia (n;14), and forearm (n;12) diaphysis fractures, respectively. Most of the fractures were seen as a result of high energy and closed middle diaphysis, the transverse fracture pattern was the most. Most of the fracture surgeries were performed with the closed method. The family satisfaction of the patients was at a high level. In the evaluation of fractures according to Flynn Criteria, most of the results were excellent, but no poor results were observed. Bone union time was higher in patients aged ten years and older and undergoing open surgery, and less in transverse fracture shape (p&amp;lt;0.05). The time not to attend school was highest in open fracture type, tibia fractures, and open surgery patients (p&amp;lt;0.05). Ulna union time was 13.1 ± 1.8 weeks, which was higher than forearm fractures (p&amp;lt;0.05). The hospital stay was 3.50 ± 0.79 / 4.29 ± 1.54 / 3.33 ± 0.49 days in femur/tibia/forearm fractures, respectively, and was the highest in tibia fractures (p&amp;lt;0.05).Conclusions: TEN is an effective and safe method for long bone diaphyseal fractures in children aged 5-15 years, with low complication rates and positive effects on the patient and the health system.

Surgical Treatment of Closed Fractures of Long Bones of Extremities with Polytrauma

The purpose of the study was to improve the functional results of treatment of patients with closed fractures of long bones of the extremities with polytrauma. Materials and methods. The results of treatment of 95 patients with fractures of long bones of the extremities with polytrauma were analyzed. Among them there were 70 (73.9%) men and 25 (26.1%) women. The victims had one or more closed fractured of the long bones of the limbs. Persons of young and able-bodied age from 31 to 50 years old prevailed – 47 (48.9%) patients. Results and discussion. Active restorative treatment was started on the second and third days after the operation at the beginning of passive movements in the joints then, as the postoperative wound healed, on the sixth and seventh days, it was active. Depending on the nature of the fractures various implants were used, in most cases, low-contract ones, which in a particular case allow achieving maximum anatomical reposition and achieving stable fixation of fragments, which provides the possibility of an early start in the development of the joint. In the immediate postoperative period in 11 patients with open fracture type B3, superficial suppuration of the soft tissues around the pins was noted, which was easily dealt with using a device for injecting drugs into the infected pin channel. Four patients with granulating wounds of the lower leg underwent autodermoplasty with a free skin graft, all 100% were healed. Phlebothrombosis developed in three patients with hip fractures: they underwent an urgent operation by angiosurgeons – vessel plexization. Long term results of treatment in terms of 8 months to 5 years were studied in 76 patients. Treatment outcomes were assessed with some criteria (union, neuro vascular disorder, varus or valgus, rotation, shortening of the limb, movement in the knee and hip joint, pain, walking hanging activity). Four patients developed chronic osteomyelitis, they underwent seguestrectomy with sub segment recovery. Delayed consolidation was noted in six patients with complex fractures (type C). Two patients developed a defect in the bones of the lower leg up to 5 sm, they subsequently underwent lengthening of the segment. Post-traumatic contracture was noted in four patients. Three patients had persistent leg edema, chronic post-traumatic thrombophletitis, equinus deformity of the feet, significant chromate – the result was rated as “poor”. According to the results of ratings as “excellent”, “good”, “satisfactory” and “poor”, quantitative designations were assigned as 5, 4, 3, 2 points, respectively. In the 76 patients studied, the long-term results were assessed as follows: in 24 (31.6%) patients the result was regarded as excellent (5 points), in 37 (48.7%) patients it was good (4 points), in 12 (15.8%) %) – satisfactory (3 points), in 3 (3.4%) – poor (2 points). Conclusion. As a result of the use of low-contact on-bone plates in the osteosynthesis of complex comminuted fractures of long bones, with combined injuries, 90.3% gave excellent and good functional results. With a combined chest injury, intramedullary osteosynthesis with a pin with reaming is contraindicated, due to the risk of developing fat embolism. In these patients, it is necessary to operate with bone plates

Impact of Polymer Rheology on Gel Treatment Performance of Horizontal Wells with Severe Channeling

Summary Gel treatment has been a cost-effective method to control the conformance of a reservoir with severe heterogeneity problems. The water channels in such reservoirs can be classified as open fractures or high permeability porous media with pore-throat network. Many simulation studies have been conducted to discuss gel treatment performance for conformance control. However, nobody considered the polymer rheology difference in open fractures and porous media in simulation. Previous simulation studies also ignored the residual resistance factor as a function of rock permeability rather than a constant parameter. In this study, a conceptual simulation model was established to simulate the linear flow system for the reservoir with horizontal wells considering the two factors mentioned above. The results demonstrate that the gel treatment always provides the better placement results in the open fracture type channel than pore-throat network type channel. Moreover, it is very necessary to consider residual resistance factor as a function of permeability, which is based on the experimental results and can provide much greater plugging efficiency in the higher permeable channels than constant residual resistance factor. Sensitivity analysis studies and multifactor analysis indicate that increasing oil viscosity and permeability ratio has a strong positive influence on conformance control results, which indicate in-situ gel treatment can be better applied in heavy or viscous oil reservoirs with fracture-like channels. Besides, the results also indicate that in reservoirs with severe channeling problem where channel velocity was high, the differences of gelant placement and profile improvement in models with two different types of channels could be enlarged greatly.

Open pelvic fractures – results of a multi-institutional study

Open pelvic fractures are devastating injuries, rare, and with high mortality. Leading causes of mortality are: haemorrhage, infection and associated injuries. The aim of this paper is to point out methods of treating these injuries and great number of prognostic mortality factors. Material - in period from January 2011 to December 2015, 221 patients with pelvis ringfracture were treated in three large clinical centers of Serbia, of which 13(5%) had an open fracture type. We have classified pelvic ring fractures according to the Young - Burgess classification. We have classified injuries according to Gustilo at I, II, and III degree, and the location of the wound according to Faringer classification was distributed in zone I, II and III. Urogenital and intra-abdominal injuries were monitored, and severity of injuries was determined according to Severity Score Injury (ISS) and Trauma Score (TS). Results - there were 6(46%) women and 7(54%) men at the average age of 41(13 - 76). Injuries from traffic trauma are dominant. The most common cause of pelvic ring fracture is an anterior posterior compression - 6(46%), lateral compression - 4(31%) and vertical force in 3 (23%) patients. Dominant injuries are type I and II according to Gustilo, and zone I according to Faringer classification. There were 6 (46%) patients with urogenital injuries, and the same number with intra-abdominal injuries, of which 3(23%) patients have been treated with colon resection and diversion. Due to abundant hemorrhage and hypovolemic shock 2 patients died, and another one died after three days due to sepsis and multisystem organ failure (MSOF). Conclusion - Open pelvic fractures have high mortality rate, due to: haemorrhage, infection, associated abdominal and genitourinary tract injuries, ISS&gt; 25, TS &lt;8 and age of patient &gt;65 years.

245. Risk Factors Associated with Open Fracture Complications Following Antibiotic Prophylaxis

BackgroundSurgical site infection is concerning after an open fracture. The Eastern Association for the Surgery of Trauma guidelines provide antibiotic selection and duration recommendations based on open fracture type. Risk factors for open fracture complications (e.g. infection, acute kidney injury [AKI], multi-drug resistant organisms [MDRO], or Clostridioides infection [C. difficile]) and overall guideline adherence are unclear at our institution.MethodsThis was a single center, retrospective study of adult patients with an open fracture who received antibiotic prophylaxis and were admitted for at least 24 hours between March 2011 and October 2020. Patients were excluded if open fracture was due to gun-shot wound, had a history of renal replacement therapy, MDRO, or C. difficile infection, were an outside hospital transfer, received antibiotics for another indication, or had a delayed presentation. The primary outcome was to identify risk factors for infection and secondary outcomes to identify risk factors for AKI, MDRO, C. difficile infection, and to evaluate guideline adherence. Patient demographics including injury details and management, microbiologic cultures, and antibiotic information were collected. Data were analyzed by univariate analysis, as appropriate, and logistic regression.ResultsA total of 401 patients met study criteria; median age 46 years, 62% male, and 77% white. Fracture classifications were similar: 30% type I, 39% type II, and 30% type III. Infection occurred in 18% of patients, AKI in 18%, MDRO in 3%, and no patients developed C. difficile. Of those with culture-positive infection, 51% grew gram-positive organisms. In bivariate analysis, fracture classification (p=0.023), medical fracture management (p=0.034), and antibiotic choice (p=0.004) were associated with infection. The only independent risk factor associated with AKI was receiving a nephrotoxic medication (p=0.012). Eighty-one percent received guideline adherent antibiotics and of those that received too narrow antibiotics, 36% developed an infection (p=0.004). ConclusionAppropriate fracture classification and antibiotic choice is crucial to reduce infection following open fracture. Reducing concomitant exposure to nephrotoxic agents may reduce the risk of AKI. Disclosures All Authors: No reported disclosures

Factors affecting quality of life of fracture patients with productive age at dr. Haryoto Regional General Hospital, Lumajang District, East Java

Background and purpose: Fractures can affect activity and productivity due to delayed time of returning to work. It may have impacts on the patient’s physical, psychological, social, and environmental conditions that can influence the quality of life. The purpose of this study was to explore factors associated with the quality of life of fracture patients with productive age.Methods: This research used a cross sectional approach conducted at the Orthopedic Clinic of dr. Haryoto Regional General Hospital, in Lumajang District, East Java from October 2020 to February 2021. The study involved 84 patients whom were selected using simple random sampling. Data was collected with interview using the WHOQOL-BREF questionnaire which can assess a person’s quality of life. The data were analysed using univariable, bivariable and multivariable analysis with Chi-square and Logistic Regression.Results: Most respondents were aged 20 to 60 years, male, have worked, completed secondary education, and married. Most of them had health insurance, experienced fractures in lower extremity with open fracture type, had severe condition since more than 12 months and had an accident on the highway. Factors associated with quality of life were family support with OR=0.631 [95%CI: 0.524-0.760; p=0.004], duration of fracture with OR=0.333 [95%CI: 0.123–0.900; p=0.049] and fracture severity with OR=11.00 [95%CI: 3.261–37.106; p=0.00]Conclusion: Family support, duration of fracture, and fracture severity were associated with quality of life of productive aged fracture patients. Special attention and family support are needed for fracture patients during the healing period to improve their health status.

Habits, attitudes, and behavior of refugees and migrants in Serbia concerning oral health

Background/Aim. Open pelvic fractures are devastating, rare injuries with high mortality. Leading causes of mortality are the following: hemorrhage, infection, and associated injuries. The aim of this study was to point out methods of treating these injuries and a great number of prognostic mortality factors. Methods. In the period from January 2011 to December 2015, 221 patients with pelvis ring fractures were treated at three large clinical centers in Serbia, of which 13 (5%) patients had an open fracture type. We have classified pelvic ring fractures according to the Young-Burgess classification. We have classified injuries according to Gustilo at I, II, and III degrees, and the location of the wound according to Faringer classification was distributed in zone I, II, and III. Urogenital and intra-abdominal injuries were monitored, and the severity of injuries was determined according to Severity Score Injury (ISS) and Trauma Score (TS). Results. There were 6 (46%) women and 7 (54%) men with an average age of 41 year (13?76). Injuries from traffic trauma were dominant. The most common causes of pelvic ring fracture were anteroposterior compression ? 6 (46%), lateral compression ? 4 (31%), and vertical force in 3 (23%) patients. Dominant injuries were types I and II according to Gustilo and zone I according to the Faringer classification. There were 6 (46%) patients with urogenital injuries and the same number with intra-abdominal injuries, of which 3 (23%) patients had been treated with colon resection and diversion. Due to abundant hemorrhage and hypovolemic shock, two patients died, and another one died after three days due to sepsis and multisystem organ failure. Conclusion. Open pelvic fractures have a high mortality rate due to: hemorrhage, infection, associated abdominal and genitourinary tract injuries, ISS &gt; 25, TS &lt; 8, and the age of patients &gt; 65 years.

Prophylactic Vancomycin-PMMA Strips are an Easy-to-Use and equally effective alternative to antibiotic beads in open fracture care

Objectives: Even under ideal conditions, infection remains a risk of surgery and can be harrowing after surgical repair of compound fractures. This study aimed to assess the efficacy and convenience of local antibiotic-impregnated polymethyl methacrylate (PMMA) strips to overcome infection and functional union within a specified time after primary definitive stabilization of compound fractures. Design:We investigated patients who received PMMA-vancomycin strips during orthopedic surgical repair of open fractures. Setting: From 2017 to 2019 in a tertiary medical center. Patients: A total of 106patients with open fractures type I through IIIC were included (age range, 24–62 years). Intervention: Patients underwent profuse wound cleaning, methodical debridement, and definitive stabilization with PMMA-vancomycin strips. Main Outcome Measurements: We measured the incidence of wound healing, fracture union, and infection rate. Patients were followed for two years with infection parameters and radiographs. The efficacy of the PMMA strips in our study with that of PMMA beads in similar procedures from published studies was compared. Results: Of 106patients, five (4.7%) had a subclinical infection until implant removal. We found no osteomyelitis or non-union in any patient. A literature search confirmed comparable outcomes in infection rates between the PMMA strips used in this study and antibiotic beads used in previous studies. However, the removal of PMMA vancomycin strips is generally more convenient compared with that of beads. Conclusions: For the controversial challenge of determining the duration to keep or remove antibiotic beads, PMMA vancomycin strips present surgeons with an easy-to-use alternative with equivalent efficacy. Keywords: Vancomycin, Polymethyl methacrylate, Beads, Strip.

RESULTS OF TREATMENT OF OPEN FRACTURES IN PATIENTS WITH POLYTRAUMA IN A REGIONAL TRAUMA SYSTEM

Aim. To analyze options for treatment tactics for open fractures of bones, implemented in a regional trauma system in theKrasnodar Territory.Materials and methods. Retrospective analysis includes the results of treatment of 82 patients with polytrauma and severe open fractures of the shin bones aged from 18 to 60 years, of whom 23 in unstable or critical condition, hospitalized in 2016-2017 in the Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital № 1.Results. Treatment tactics for patients with severe polytrauma and open fractures type IIIA and B according to the classification of Gustilo-Andersen adopted in trauma center of level I, reduces the total number of infectious complications to 9,09% for fractures of type III A and 53,84% of IIIB fractures compared to option treatment strategies adopted in trauma centres II, III where the level of infection reaches 58,06% fractures type III A and 93,75% of IIIB fractures. The typical mistakes made in primary surgical treatment in patients with polytrauma and severe open fractures were revealed: incomplete revision of the wound with leaving foreign bodies, non-viable soft tissues, unstable fixation of the fracture with the help of a skeletal traction system, incomplete external fixation of the fracture with a device or plaster bandage, suturing of the wound with relaxing skin incisions during soft tissue swelling, absence of drains or passive drainage of the open fracture.Conclusion. The usage of primary surgical treatment in a reduced volume, with the application of VAC-dressings, in patients with polytrauma and severe open fractures of the limb bones can reduce the overall incidence of infectious complications.

Noncontact plating technique in an open fracture

AimIn comparison with closed fractures, open fractures have an increased risk of infection, there are soft tissue-related problems, and difficulties are experienced in union. The aim of this study was to evaluate and discuss the results of osteosynthesis applied with a noncontact plate in Gustilo–Anderson Type 2, 3a, and 3b fractures.MethodThe study included 23 patients applied with debridement + noncontact plate osteosynthesis + soft tissue procedures in a single session for the treatment of an open fracture. A follow-up card was created to evaluate the patients in respect of age, gender, fracture level, fracture etiology, open fracture type, preoperative and postoperative sedimentation and C-reactive protein values, antibiotics used and duration of use, time to union, and complications.ResultsIn all 23 patients, full bone union was obtained at mean 22.5 weeks (range: 16–36 weeks). Complications developed in 9 patients. Implant failure occurred in 3 patients. In 5 patients, infection developed which required repeated debridements.ConclusionIn open fractures, noncontact plating following debridement seems to be a good alternative treatment method to intramedullar nailing, especially in metaphyseal and metaphyseo-diaphyseal fractures and in spiral oblique diafiz fractures. Noncontact plating may also be a good alternative to intramedullar nailing for open fracture treatment if the patients have additional pathologies such as contusion and thoracic injury.

The effect of systemic injury score on the decision making of mangled lower extremities

PurposeMangled lower extremity with Mangled extremity severity score (MESS) more than 7 are considered unsalvageable. We are looking for a factor helps us predicting the salvage potential in the patient with MESS score between 7 and 9. Materials and methodsWe reviewed the patients with lower extremities open fracture type IIIB or IIIC and received salvaged procedure or amputation in CGMH between 2002/01 and 2010/09. The patients are subgroup according to their MESS score. ISS score, Gustilo open fracture classification were compared between patient with successful salvage and patient with delay amputation. Logistic regression and stepwise modeling were used to determine the effect of each covariate. Results242 patients were enrolled in the study. 33 patients had primary amputation, 160 patients had successfully salvaged limbs and 49 patients received delay amputation. Among patients with MESS score less than 7, 116 patients had successful salvage limbs and 7 patients received delay amputation. Among patient with MESS between 7 and 9, 44 patients discharged with salvaged limbs and 39 patients were failed to salvage their limbs. Successful salvaged patients in this group had significant lower ISS score in compare to delay amputated patients. Patients with ISS score more than 18 in this group has higher delay amputated rate (P value=0.01). ConclusionSystemic injury severity score can help us tell potentially salvaged patient from potentially amputated patient. In patients with MESS score between 7 and 9 concurrently have ISS score less then 17 are potentially salvageable. Level of Evidence & Study Type: Level 3 Retrospective cohort study/prognostic study

Causes of open fractures: orthopaedic injuries related to home-made agricultural vehicles in the eastern Black Sea region of Turkey.

Small vehicles known locally as pat-pats, which are used in agricultural work, are forbidden in traffic. The inherent instability of the vehicle may result in accidents, both on farmland and in traffic. The aim of this study was to evaluate orthopaedic injuries related to pat-pats. Patients hospitalised for pat-pat accidents in two central hospitals in Samsun between December 2006 and October 2013 were scanned using ICD codes. A total of 46 patients with orthopaedic injuries (43 male, 3 female) with a mean age of 36 ± 13.3 years were evaluated. The most injured age group was between 10 and 49 years (n = 40, 87%), and accidents occurred most in summer (n = 30, 65%). Open fractures were determined in 42 (91%) patients. Amputation was necessary in 4 (8%) patients. The hospitalisation period was a mean of 17.1 ± 14 days. A statistically significant relationship was determined between open fracture type and the hospitalisation period (P < 0.001). As most of the orthopaedic injuries related to home-made agricultural machines are open fractures, it is important to guard against these types of injuries. The regulations that these machines are not used in traffic should be enforced and safer practices should be applied for use in agriculture.

Risk Factors for Infection and Amputation Following Open, Combat-Related Calcaneal Fractures

High-energy open calcaneal fractures are severe injuries complicated by high rates of infection, uncertain functional outcomes, and frequent need for later amputation. We conducted a retrospective review of 102 consecutive combat-related open calcaneal fractures. Patient demographics, injury mechanisms, fracture and wound characteristics, associated fractures, and methods of fracture fixation were reviewed to determine risk factors for eventual amputation or infection. Eighty-nine patients, with a mean age of twenty-six years, sustained 102 open calcaneal fractures (thirteen bilateral). After a mean follow-up of four years (range, five to ninety-two months), 42% (forty-three limbs) underwent amputation. A delayed amputation (more than twelve weeks from the time of injury) was performed in 15% (fifteen) of 102 open calcaneal fractures. In a multivariate Cox proportional-hazards survival model with time to amputation as the end point, the blast mechanism of injury, plantar wound location, larger size of open wound (in square centimeters), and escalating Gustilo and Anderson classification types (p < 0.05 for all) were predictive of eventual amputation. At the time of the final follow-up, patients who had undergone amputation had lower visual analogue scale scores for pain (2.1 compared with 4.0; p < 0.0001) and higher Tegner activity levels (5.4 compared with 3.5; p < 0.0001) than limb salvage patients. Lower-extremity amputation following open calcaneal fractures is predicted by the injury mechanism, wound location and size, and open fracture type and severity. After short-term follow-up, patients with open calcaneal fractures eventually requiring amputation exhibit improved pain and activity levels compared with patients with continued, ostensibly successful limb salvage.

Open fractures of the tibia in the pediatric population: a systematic review.

The management of open fractures of the tibia in a pediatric population represents a challenge to the clinician. Several case series over the course of many years have been performed describing the results of treating these injuries. It remains unclear, however, whether there is a preferred modality of treatment for these injuries, if a more severe injury confers a greater risk of infection, and if time to union is affected by Gustilo type, although trends seem to exist. The purpose of this study was to assemble the available data to determine (1) the risk of infection and time to union of various subtypes of open tibia fractures in children and (2) the changes in treatment pattern over the past three decades. A systematic review of the available literature was performed. Frequency weighted mean union times were used to compare union times for different types of open fractures. Mantel Haentzel cumulative odds ratios were used to compare infection risk between different types of open fractures. Linear regression by year was used to determine treatment practices over time. No significant change in practice patterns was found for type I and III fractures, although type II fractures were more likely to be treated closed in the later years of the study compared to the earlier years. Type III fractures conferred a 3.5- and 2.3-fold greater odds of infection than type I and type II fractures, respectively. There was no significant difference in odds of infection between type I and II fractures. There was a significant delay in mean time to union between type I and type II fractures, and between type II and type III fractures. With the exception of type II fractures, the philosophy of treatment of open fractures of the tibia has not significantly changed over the past three decades. Closed treatment or internal fixation are both viable options for type II fractures based on their relatively low incidence of infection. This study also demonstrates a strong relationship between Gustillo sub-types and odds of infection in this population. Not surprisingly, union rates are also delayed with increasing injury severity.

On the occurrence and formation of open fractures in the Jurassic reservoir sandstones of the Snøhvit Field, SW Barents Sea

Open fractures were described in core and Formation Micro Image (FMI) image logs in the Jurassic sandstones of the Tubåen, Nordmela and Stø formations in the Snøhvit Field, and 3D fracture network properties analysed using Computer Tomography (CT)scanning in selected core samples. The most frequent open fracture type is short stylolite-related fractures (F1), but longer open fractures are also present, with no obvious relationship to stylolites (F2). The F1 fracture densities are related generally to the clay content of the host rock, which controls the occurrence and spacing of the stylolites. The fractures are steep, with a N–S-dominant strike azimuth and significant spread. Although, generally, the F1 fractures are short, a percolating and 3D connected open fracture network across the core was found in most of the CT-scan samples. Open fractures were also found in the damage zone of a lately reactivated fault. The formation of the open fractures in the Snøhvit Field is related most likely to thermoelastic processes during removal of overburden in late Tertiary time. The presence of open fractures may influence reservoir flow, particularly in intervals containing a high frequency of stylolites and in the damage zones of reactivated faults.