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Current management of open fractures: results from an online survey

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Open fractures are orthopaedic emergencies that carry a high risk for infection, non-union and soft tissue complications. Evidence-based treatment is impeded by the lack of high-quality evidence-based studies. The aim of this investigation was to elucidate the current practice of open fracture management in Germany and to determine major differences in treatment.

Methods

Surgeons were asked to complete an online questionnaire consisting of 45 items developed by an expert consensus. The first part covered questions on general principles of open fracture management. The second part included questions on soft tissue management, the preferred method of initial surgical stabilisation, microbiological testing, employment of pulsatile lavage and local antibiotics, antibiotic regimen, second-look operations, and blood testing.

Results

Of 653 respondents, 364 (65 %) completed the first part and 314 (48 %) completed the second part of the online survey. 55 % answered that a standard operating procedure for the diagnosis and treatment of patients with open fractures exists in their hospital. Only 25 % leave pre-hospitalisation applied dressings intact until arrival of the patient in the operating room, and 40 % make this decision depending on information provided by pre-hospitalisation emergency personnel. 84 % participants exclude the use of antibiotic-coated implants in the treatment of open fractures. The favoured stabilisation method in Gustilo type I fractures is definitive internal osteosynthesis and primary wound closure for 61 % of respondents. In Gustilo type II (74 %) and type III fractures (93 %), temporary external fixation is preferred. High-pressure pulsatile lavage is used by 22 % responding surgeons in Gustilo type I fractures, 53 % for type II fractures and 67 % for type III fractures.

Conclusions

Open fracture management differs considerably among surgeons in Germany. Further studies are needed to deliver high-quality evidence concerning primary fracture stabilisation, soft tissue management and second-look operations. Existing evidence-based recommendations for general treatment, antibiotic prophylaxis and soft tissue management should be followed more strictly in clinical practice.

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Acknowledgments

The authors would like to acknowledge all members of the Sektion NIS of the German Trauma Society (DGU) who gave their thoughtful comments during survey initiation and internal presentations.

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Authors and Affiliations

  1. Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Germany

    Denis Gümbel, Gerrit Matthes & Axel Ekkernkamp

  2. Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany

    Denis Gümbel, Gerrit Matthes, Matthias Napp, Jörn Lange, Peter Hinz, Romy Spitzmüller & Axel Ekkernkamp

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Correspondence to Denis Gümbel.

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All authors disclose any funding received for this work by the following organisations: National Institute of Health (NIH); Wellcome Trust; and the Howard Hughes Medical Institute (HHMI).

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Gümbel, D., Matthes, G., Napp, M. et al. Current management of open fractures: results from an online survey. Arch Orthop Trauma Surg 136, 1663–1672 (2016). https://doi.org/10.1007/s00402-016-2566-x

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