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| Amna Diwan,Kyle R. Eberlin,Raymond Malcolm Smith.[J].Chin J Traumatol,2018,21(4):187-192. 10.1016/j.cjtee.2018.01.002 |
| The principles and practice of open fracture care, 2018 |
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| DOI：10.1016/j.cjtee.2018.01.002 |
| KeyWord: Open fracturesDebridementBony stabilizationEarly healthy soft tissue cover |
| FundProject: |
| Author Name | Affiliation | | Amna Diwan | University of Massachusetts Medical School, Department of Orthopedics and Rehabilitation, UMASS Memorial Medical Centre, Worcester, MA, USA | | Kyle R. Eberlin | Department of Surgery, Harvard Medical School, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA | | Raymond Malcolm Smith | Department of Orthopaedics, Harvard Medical School, Chief Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, MA, USA |
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| Abstract: |
| The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction.
Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover. As the injuries become more complex this involves progressively more complex soft tissue reconstruction and may even requiring urgent free tissue transfer requiring close co-operative care between orthopaedic and plastic surgeons. Data suggests that the best results are obtained when the whole surgical reconstruction is completed within 48-72 h. |
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