Abstract
Aim
Infection rates after management of open fractures are still high. Existing guidelines regarding prevention of this complication are inhomogeneous. A survey directed to orthopaedic trauma surgeons worldwide aims to give an overview of current practices in the management of open fractures.
Method
An international group of trauma surgeons and infection specialists with experience in the field of musculoskeletal infections developed a questionnaire that was distributed via email to all AOTrauma members worldwide. Descriptive statistical analysis was performed.
Results
1197 orthopaedic trauma surgeons answered the survey (response rate: 4,9% of all opened emails). Cephalosporins are the most commonly used antibiotics for systemic prophylaxis in open fractures (cefazolin: 51,46% cefuroxime: 23,6%, ceftriaxone: 14,54%). In Gustilo type III open fractures gentamicin (49,12%) and metronidazole (33,58%) are often added. 86% (n=1033) reported to give the first dosage of systemic antibiotics in the emergency department as soon as the patient arrives. Only 3% (n=34) reported pre-hospital administration at the scene of the accident or during transport to the hospital. While most respondents administer antibiotics over 24h in type I open fractures (34%, n=405), for type II open fractures the most often mentioned duration is 72h (26%, n=306). For type III a 7 days course was most often performed (38%, n=448). Overall, there is a tendency to longer durations with increasing severity. However, a vast majority agreed that the optimal duration is not well defined in the literature (71%, n=849).
20psi,”Jet-Lavage”). The amount of irrigation fluid has a bimodal distribution with two peaks at 4–6 liters (24%, n=286) and at 8–10 liters (24%, n=282).
Conclusions
Results from our survey give an overview of current practices and identify certain aspects in the management of open fractures where treatment protocols are very heterogenous and guidelines not well accepted. These controversies demand for further research in this field to provide better evidence.
