Experimental and clinical studies indicate that parenteral administration of appropriate antibiotics within three hours after injury helps to prevent wound sepsis. Update on the management of compound lower limb fractures. The gustilo and anderson classification of open fractures 5 gustilo rb, anderson jt. Gustilo anderson classification gustilo anderson classification kim, paul. Tibial nail combined with vacuum sealing drainage for. The effect of surgical delay on acute infection following 554. Gustiloanderson classification article pdf available in clinical orthopaedics and related research 47011. Steppingstones to the implementation of an inhospital.
In a retrospective study of 104 pediatric patients who. Total 147 patients with single open fracture in proximal or middle. Bone grafting via reamerirrigatoraspirator for nonunion. The analysis included 554 open fractures in 536 consecutive patients who were eighteen years of age or younger. Unreamed intramedullary nailing is a better alternative than external fixator for gustilo grade iiib tibial fractures based on a metaanalysis f. Based on the gustilo and anderson classification, 3061 49% type iiia fractures, 1561 25% type iiib. Clinical study on postoperative infection of open tibial. Department of orthopaedics and trauma,xian honghui. Clinically, it remains a challenge for orthopedic and plastic surgeons to treat open tibia fractures due to frequent multiple injuries 2, 3. Twentytwo patients had an associated fibular fracture. This system uses the amount of energy, the extent of softtissue injury and the extent of contamination for determination. Gustilo, anderson, tejidos blandos, fracturas expuestas.
The optimal timing for surgical stabilization after open fractures of proximal and middle phalangeal shaft remained unclear. All patients between 15 and 65 years of age with a minimum of sixmonth followup were included. However, among 10 patients with gustilo grade iiia fractures in the l group, 5 50% developed postoperative infection 2 patients 20% with superficial infection and 3 30% with deep infection. Reducing hospitalbased delays in receiving care, and, in particular, improving interfacility referral systems are the most substantial tools for reducing delays in admissions to hospital. The infection rate was 3% twelve of 344 for fractures.
Retrospective comparison of postoperative infection and bone. Clinical study on postoperative infection of open tibial fracture with different debridement timing. Download as ppt, pdf, txt or read online from scribd. An audit of the establishment process, feasibility of the registry work and report of the collected data is given. Exposicion fracturas expuestas linkedin slideshare. Third degree open fractures and traumatic subtotal amputations of. Acute shortening and lengthening following vascular repair with a. Patients with open tibia fractures treated with reamed intramedullary nail imn across a 10year period were evaluated. The role of antibiotic therapy in open fractures is secondary to adequate debridement, irrigation, and definitive wound care.
The gustiloanderson classification system as predictor of. Use of antimicrobials in the management of open fractures. Hans christian andersen andersen, hans christian 18051875 a danish writer who is remembered as one of the worlds greatest storytellers. Unreamed intramedullary nailing is a better alternative. Musculoskeletal trauma represents a considerable global health burden, however reliable populationbased incidence data are scarce. Background the challenges of managing gustilo iiib tibial fractures in children are unique. Pdf on may 9, 2012, paul h kim and others published gustiloanderson classification find, read and cite all the research you need on. In lowincome and middleincome countries, timely hospital admission remains largely inaccessible, especially among patients with open fractures. The gustilo anderson classification, also known as the gustilo classification, is the most widely accepted classification system of open or compound fractures the grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications. Most injuries involved the distal tibia n 8 and were metaphyseal n 8. Gustilo open fracture classification is the most commonly used method to classify open fractures, to guide treatment and to predict clinical outcomes. Prevention of infection in the treatment of one thousand and twentyfive open fractures of long bones.
Open tibia diaphysis fractures are complex injuries a ssociated with a. Finally, the gustilo anderson classification incorporates treatment concepts into the classification. The open tibial fractures were graded using the gustilo open fracture classification as follows. Management of gustiloanderson type ii and iiia open long bo. The two patients sustained gustiloanderson type iiic open fractures one patient in the tibia and the other patient in the. May 09, 2012 gustiloanderson classification gustiloanderson classification kim, paul. A novel rat model of tibial fracture for trauma researches. The outcomes for open tibial fractures with severe soft tissue injury are still a great challenge for all the trauma surgeons in the treatment.
Fracturas abiertas gustillo y anderson allgower 1971 grado i. Delays in hospital admissions in patients with fractures. Tibial nail combined with vacuum sealing drainage for gustilo. Timing for surgical stabilization with kwires after open. Bone grafting via reamerirrigatoraspirator for nonunion of. Fitzgerald am, gaston p, wilson y, quaba a, mcqueen mm. It was created by ramon gustilo and anderson, and then further expanded by gustilo, mendoza, and williams. Sep 22, 2016 we sought to conduct the largest retrospective study to date of open tibia fractures and describe the incidence of complications and evaluate the potential predictive risk factors for complications. However, problems such as the limitation of joint activities, post ankylosis, pin tract infection, and inconvenience of patient care were hard to be solved. At a level1 pediatric trauma center, 96 patients younger than 18 y who sustained gustiloanderson grade ii and iiia open long bone fractures. Images of a 42yearold male patient with a gustilo grade iiib open tibial fracture. Gustilo and anderson classification of open fractures.
Advanced trauma life support is the first line of action in dealing with open fractures and to rule out other lifethreatening condition in cases of trauma. The open tibia fracture is the most common open long bone fracture, and 29. Although most of his poems, novels, and dramas have been forgotten, his fairy tales, compiled 1835 1872, have gained him lasting fame. Problems in the management of type iii severe open fractures. Oct 24, 2019 the outcomes for open tibial fractures with severe soft tissue injury are still a great challenge for all the trauma surgeons in the treatment. Accordance with the gustilo anderson classification for open injuries, 15 cases were classified as type i and 20 cases as type ii.
Gustiloanderson classification, clinical orthopaedics and. The shadow one of hans christian andersens fairy tales. This system uses the amount of energy, the extent of softtissue injury and the extent of contamination for determination of fracture severity. All fractures were classified according to gustilo anderson classification. All open fractures were subjected to a standard treatment protocol at htaa, which includes the use of prophylactic antibiotics, emergency debridement, fracture stabilisation, wound coverage. The classification committee of the orthopaedic trauma association ota proposed.
Postoperative complications are frequent, and according to the literature, open reduction and plate fixation is thought to be associated with higher complication rates. Fractures in the grade iiib category are 10cm open fractures that are associated with extensive soft tissue loss but no substantial vascular damage. The timing of operative debridement can be debated. The gustilo classification has been shown to have only a moderate interobserver reliability 2,3. Retrospective comparison of postoperative infection and. We sought to conduct the largest retrospective study to date of open tibia fractures and describe the incidence of complications and evaluate the potential predictive risk factors for complications. Govender s, csimma c, genant hk, valentinopran a, amit y. The gustilo classification of open compound fractures located in the extremities is based on criteria that include trauma severity, size, injury to vascular and soft tissue, degree of displacement, and injury contamination 1, 2. It is a bone fracture associated with a break in the skin continuity which can cause complications such as infection, malunion, and nonunion. Our goal is to investigate a novel tibial fracture model providing different fractures.
Clasificacion gustilo anatomia humana medicina clinica. The management of open fractures j bone joint surg am 1990. Demographic data, fracture type and location, mode of treatment. The effect of surgical delay on acute infection following. The gustiloanderson classification system as predictor of nonunion. We examined 85 open tibial shaft fractures 85 patients treated with l or immediate i imn from january 2004 to december 2010. The l and i groups comprised 37 33 men, 4 women and 48 44 men, 4 women patients, respectively. Fairy tales of hans christian andersen the shadow hans.
Controversies in the management of open fractures fulltext. Download as pptx, pdf, txt or read online from scribd. Even after 40 years since gustilo and anderson first proposed a classification of open fractures, a universally acceptable, valid and reliable classification system of open fractures remains elusive. Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. The gustilo open fracture classification system is the most commonly used classification system for open fractures. According to the ruediallgower classification for pilon fractures, 8 cases were classified as type i, 12 cases as type ii, and 15 cases as type iii.
Tibial plateau fractures orthopaedic trauma association ota. Postsurgical anteroposterior c and lateral d radiographs. A fracture and dislocation registry was established within a welldefined population. Open fracture is a type of bone fracture in orthopedics, frequently caused by high energy trauma. Early attempts by veliskakis 29 at grading open fractures were refined by gustilo and anderson in 1976 16. Aug 01, 2009 background the challenges of managing gustilo iiib tibial fractures in children are unique. Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones j bone joint surg am 1976.
Complications after surgical management of distal lower. Open reduction and internal fixation of gustilo typei and. Seven injuries were gustilo anderson iiia and eight were iiib injuries, requiring either fasciocutaneous or myofasciocutaneous coverage. However, most of the existing open tibial fracture models can only provide minimal soft tissue injury which cannot meet the requirement of severe trauma research. No significant difference was seen in the postoperative infection rate of patients with gustilo grades iii fractures between the two groups. The new classification was tested for interobserver reliability on five different fractures classified by 15 surgeons each using the krippendorffs alpha.
It was created by ramon gustilo and anderson, and then further expanded. Unreamed intramedullary nailing is a better alternative than. Standards for the management of open lower limb fractures bapras. Osseous healing of distal lower leg fractures can be prolonged and is often associated with wound healing problems because of the marginal soft tissue and vascular supply in this area. The gustilo and anderson grading is widely used and is relatively simple, but. We devised a new unified classification of open fractures based on the gustilo and ota classification systems. Methods this was a retrospective comparative study of trauma registry data from an emergency medical care center university hospital. A multidisciplinary, evidence based approach is needed. As the two commonly used methods for gustilo grade iiib tibial fractures, unreamed intramedullary nailing uin and external fixation ef.
1419 283 369 938 432 1479 924 1305 1398 1500 216 1344 1080 226 240 729 1384 409 261 595 938 1031 541 316 371 919 370 1298 1469 309