Abstract
Objectives: Open fractures are one of the injuries with the highest rate of infection that orthopaedic trauma surgeons treat. The main purpose of this survey was to determine current practice and practice variation among Orthopaedic Trauma Association (OTA) members and make treatment recommendations based on previously published resources. Design: Survey. Setting: Web-based survey. Participants: Three hundred seventy-nine orthopaedic trauma surgeons. Methods: A 15-item questionnaire-based study titled "OTA Open Fracture Survey" was constructed. The survey was delivered to all OTA membership categories. Different components of the data charts were used to analyze numerous aspects of open fracture management, focusing on parameters of initial and definitive treatment. Results: Eighty-six percent of participants responded that a period of time of less than 1 hour is the optimal time to antibiotic administration after identification of open fracture. Despite concerns with nephrotoxicity, 24.0%-76.3% of respondents reported the use of aminoglycosides in management of open fractures. A little over half of survey respondents continue antibiotics until next debridement in wounds that were not definitively closed after initial debridement and stabilization. Conclusions: Rapid administration of antibiotics in open fracture management is important. Aminoglycoside use is still prevalent despite evidence questioning efficacy and toxicity concerns. Time to debridement of open fractures is controversial among OTA members. Antibiotic administration is commonly continued >48 hours despite concerns raised by Surgical Infection Society and The Eastern Association of the Surgery of Trauma. Regarding study logistics, survey participation reminders should be used when conducting this type of study as it can increase data accrual by 50%.
| Original language | English (US) |
|---|---|
| Pages (from-to) | e198-e202 |
| Journal | Journal of orthopaedic trauma |
| Volume | 28 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2014 |
Bibliographical note
Funding Information:The project described was supported by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Funding Information:
W.T.O. receives consulting fees from legal representatives and his institution is receiving a grant from the Department of Defense. P.T. is salaried and supported by publication royalties from Smith & Nephew and Wolters Kluwer/Lippincott William & Wilkins; holds the intellectual property rights/patent and royalties from Smith & Nephew; and receives consulting fees from Smith & Nephew. J.A. receives consulting fees from AO and Synthes, and his institution is currently receiving a grant from the Department of Defense. A.S. is current board member of the Orthopaedic Trauma Association, receives consulting and lecture fees from Medtronic, Inc., and his institution is currently receiving a grant from the Department of Defense. R.P. certifies that he has or may receive payments or benefits, during the study period, an amount of US $10,000 to US $100,000 from Stryker Orthopaedics, Mahwah, NJ. R P. is on the Board of Trustees of Scott & White Healthcare and Chair, Board of Directors of Scott & White Memorial Hospital. For the remaining authors none were declared. The project described was supported by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Funding Information:
W.T.O. receives consulting fees from legal representatives and his institution is receiving a grant from the Department of Defense. P.T. is salaried and supported by publication royalties from Smith & Nephew and Wolters Kluwer/ Lippincott William & Wilkins; holds the intellectual property rights/patent and royalties from Smith & Nephew; and receives consulting fees from Smith & Nephew. J.A. receives consulting fees from AO and Synthes, and his institution is currently receiving a grant from the Department of Defense. A.S. is current board member of the Orthopaedic Trauma Association, receives consulting and lecture fees from Medtronic, Inc., and his institution is currently receiving a grant from the Department of Defense. R.P. certifies that he has or may receive payments or benefits, during the study period, an amount of US $10,000 to US $100,000 from Stryker Orthopaedics, Mahwah, NJ. R P. is on the Board of Trustees of Scott & White Healthcare and Chair, Board of Directors of Scott & White Memorial Hospital. For the remaining authors none were declared.
Publisher Copyright:
Copyright © 2013 by Lippincott Williams & Wilkins.
Keywords
- Antibiotic prophylaxis
- Open fractures
- Time to closure Level of Evidence: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence