开放骨折 值得看.pptVIP

Infections in Orthopaedic TraumaMinimizing Infections After OpenFractures Barnaby Dedmond, MD GUSTILO ANDERSON 19761 Types 1, 2, 3 Updated 19842 Types 3A, 3B, 3C Classification—Why do we care? Classification correlates with prognosis Antibiotics in Open Fractures The use of antibiotics in open fractures has a protective effect against early infection compared with no antibiotics or placebo (Relative risk 0.41) Choice of Antibiotics in Open Fractures No difference in infection rates between clindamycin and cefazolin (anything vs S. aureus will work) Choice of Antibiotics in Open Fractures Due to gram negative contamination, add aminoglycoside for Grade 3 Farm injuries and Vascular injuries, give ampicillin or penicillin Don’t forget tetanus Duration ofAntibiotics in Open Fractures In a double blind, prospective trial, no difference in infection rates between 1 and 5 days of post operative antibiotics in open fractures Initial ID Timing Classic: within 6 hours Recently being challenged No infections in 91 isolated open Type 1 fractures treated without ID (except at time of fixation on avg 5 days after injury)1 No difference in infection rate in children will all types of open fractures treated 0-6 hours and 7-24 hours from time of injury2 I still consider all open fractures emergencies The Irrigation Amount No good data Animal studies show improved removal of particulate matter and bacteria but effect plateaus at a level dependent on the system Anglen recommends 3L for Gr 1, 6L for Gr 2, 9L for Gr 3 The Irrigation The Delivery Method Bulb Syringe vs. Pulsatile Lavage Animal study shows pulsatile lavage has a detrimental effect on early bone healing, but this effect is no longer present at 2 weeks1 Animal study shows more soft tissue destruction with pulsatile lavage2 Animal study shows pulsatile lavage to be more effective in removing particulate matter and bacteria3 Low pressure pulsatile lavage may result in fewer infections (ongoing study)