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Skeletal Stabilization In Open Injuries

May 10, 2018/in May - Aug | volume 4 | issue 1| 2018

Vol 4 | Issue 1 | May – Aug 2018 | page: 12-14 | Dheenadhayalan J, Raja Bhaskara Rajasekaran, Sivakumar S P, Ramesh Perumal, Arun Kamal C. Author: Dheenadhayalan J [1], Raja Bhaskara Rajasekaran [1], Sivakumar S P [1], Ramesh Perumal [1], Arun Kamal C [1]. [1] Department of Orhtopaedics & Trauma Ganga Medical Centre […]

Management of Open Injuries: What has changed?

May 10, 2018/in May - Aug | volume 4 | issue 1| 2018

Vol 4 | Issue 1 | May – Aug 2018 | page: 7-11 | Devendra Agraharam, Arun Kamal C, Raja Bhaskara Rajasekaran, Vel Murugesan P, Ramesh Perumal, Dheenadhayalan J. Author: Devendra Agraharam [1], Arun Kamal C [1], Raja Bhaskara Rajasekaran [1], Vel Murugesan P [1], Ramesh Perumal [1], Dheenadhayalan J [1]. [1] Department of Orhtopaedics & […]

Skeletal Stabilization In Open Injuries

May 10, 2018/in May - Aug | volume 4 | issue 1| 2018

Management of Open Injuries: What has changed?

May 10, 2018/in May - Aug | volume 4 | issue 1| 2018

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Skeletal Stabilization In Open Injuries

May 10, 2018/in May - Aug | volume 4 | issue 1| 2018

Vol 4 | Issue 1 | May – Aug 2018 | page: 12-14 | Dheenadhayalan J, Raja Bhaskara Rajasekaran, Sivakumar S P, Ramesh Perumal, Arun Kamal C.

Author: Dheenadhayalan J [1], Raja Bhaskara Rajasekaran [1], Sivakumar S P [1], Ramesh Perumal [1], Arun Kamal C [1].

[1] Department of Orhtopaedics & Trauma Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam road, Coimbatore, India

Address of Correspondence
Dr. Raja Bhaskara Rajasekaran,
Ganga Hospital, Mettupalayam road,Coimbatore, India
Email: rajalibra299@gmail.com

Abstract

Skeletal Stabilization in open injuries is as important as soft tissue cover in providing a good outcome following open injuries. Unilateral external fixator forms the workhorse of open injuries of the lower limb. In fractured ends with good bone circumference, good reduction and fixation leads to primary union. Primary internal fixation was considered unacceptable even about two decades ago in open injuries. However, nowadays following refinement in techniques of debridement, the pendulum has now swung towards early internal fixation whenever indicated. Definitive internal fixation before soft tissue cover has also shown to give good results.Modern multiplanar and circular fixators are used if there is significant contamination, bone loss and multilevel fractures of the tibia.
Keywords: Skeletal stabilization, external fixator, debridement, primary internal fixation

References

1. Giannoudis PV, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br. 2006;88:281–289
2. Carroll EA, Koman LA. External fixation and temporary stabilization of femoral and tibial trauma. J SurgOrthp Adv. 2011;20:74–81.
3. Initial Management of Open Fractures. (Book Chapter) S. Rajasekaran et al. Rockwood and Green’s Fractures in Adults. Eigth Edition. Vol1 :353-396.
4. BAPRAS Guidelines: Standards for management of open fractures of the lower limb. 2009.
5. Hyman J, Moore T. Anatomy of the distal knee joint and pyarthrosis following external fixation. J Orthop Trauma. 1999;13:241–246
6. Lethaby A, Temple J, Santy J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database Syst Reviews. 2008;(4).
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9. Giannoudis PV, Furlong AJ, MacDonald DA, et al. Reamed against unreamed nailing of the femoral diaphysis: A retrospective study of healing time. Injury. 1997;28:15–18.
10. Kakar S, Tornetta P 3rd. Open fractures of the tibia treated by immediate intramedullary tibial nail insertion without reaming: A prospective study. J Orthop Trauma. 2007;21:153–157.
11. Bhandari M, Guyatt GH, Swiontkowski MF, et al. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br. 2001;83:62–68.

How to Cite this article: Dheenadhayalan J , Rajasekaran R B, Sivakumar S P, Perumal R, Arun Kamal C. Skeletal Stabilization In Open Injuries. Trauma International May -Aug 2018;4(1):12-14.

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Management of Open Injuries: What has changed?

May 10, 2018/in May - Aug | volume 4 | issue 1| 2018

Vol 4 | Issue 1 | May – Aug 2018 | page: 7-11 | Devendra Agraharam, Arun Kamal C, Raja Bhaskara Rajasekaran, Vel Murugesan P, Ramesh Perumal, Dheenadhayalan J.

Author: Devendra Agraharam [1], Arun Kamal C [1], Raja Bhaskara Rajasekaran [1], Vel Murugesan P [1], Ramesh Perumal [1], Dheenadhayalan J [1].

[1] Department of Orhtopaedics & Trauma Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam road, Coimbatore, India

Address of Correspondence
Dr. Raja Bhaskara Rajasekaran,
Ganga Hospital, Mettupalayam road,Coimbatore, India
Email: rajalibra299@gmail.com

Abstract

Introduction: Open injuries pose a major problem to the treating surgeon as they are prone to higher rates of infection and non-union and are usually associated with life threatening polytrauma. Nowadays, specialized trauma centres and a multimodal team approach have shown to give superior results in the outcome following open injuries. Early wound debridement, early fracture stabilization and early wound closure are important components as nowadays we focus on the ‘Era of functional restoration’. Serum Lactate is a widely used biochemical marker to assess the adequacy of tissue resuscitation and the Ganga Hospital Open Injury score (GHOIS) has a higher specificity towards limb salvage and also gives guidelines regarding timing and type of soft tissue reconstruction. A combined ‘Orthoplastic’ approach in the management of open injuries and adherence to the ‘Revised reconstruction ladder’ with regarding to wound coverage has shown to a favourable outcome.
Keywords: Open fractures, Debridement, Serum lactate, Ganga Hospital Open Injury score

References

1. Dabezies EJ and D’Ambrosia RD. Treatment of the multiply injured patient: plans for treatment and problems of major trauma. Instructional course lectures 1984; 33: 242-52.
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4. Simons R, Eliopoulos V, Laflamme D, and Brown DR. Impact on process of trauma care delivery 1 year after the introduction of a trauma program in a provincial trauma center. The Journal of trauma 1999; 46: 811-5
5. Initial Management of Open Fractures .(Book Chapter) S. Rajasekaran et al. Rockwood and Green’s Fractures in Adults. Eigth Edition . Vol 1 :353-396.
6. Pollak AN. Timing of debridement of open fractures. The Journal of the American Academy of Orthopaedic Surgeons 2006; 14: S48-51.
7. Carsenti-Etesse H, Doyon F, Desplaces N, and et al. Epidemiology of bacterial infection during management of open leg fractures. Eur J Clin Microbiol Infect Dis 1999; 18: 315-323.
8. Kreder HJ and Armstrong P. The significance of perioperative cultures in open pediatric lower-extremity fractures. Clinical orthopaedics and related research 1994: 206-12.
9. Lee J. Efficacy of cultures in the management of open fractures. Clinical orthopaedics and related research 1997: 71-5.
10. Patzakis MJ. Orthopedics-epitomes of progress: The use of antibiotics in open fractures. The Western journal of medicine 1979; 130: 62.
11. Edwards CC, Simmons SC, Browner BD, and Weigel MC. Severe open tibial fractures. Results treating 202 injuries with external fixation. Clinical orthopaedics and related research 1988: 98-115.
12. Emami A, Mjoberg B, Ragnarsson B, and Larsson S. Changing epidemiology of tibial shaft fractures. 513 cases compared between 1971-1975 and 1986-1990. Acta Orthop Scand 1996; 67: 557-561
13. Rajasekaran S and Giannoudis PV. Open injuries of the lower extremity: issues and unknown frontiers. Injury 2012; 43: 1783-4
14. Gustilo RB. Management of infected fractures. Instructional course lectures 1982; 31: 18-29.
15. Rajasekaran S, Naresh Babu J, Dheenadhayalan J, Shetty AP, Sundararajan SR, Kumar M, and Rajasabapathy S. A score for predicting salvage and outcome in Gustilo type-IIIA and type-IIIB open tibial fractures. The Journal of bone and joint surgery. British volume 2006; 88: 1351-60.
16. Rajasekaran S and Sabapathy SR. A philosophy of care of open injuries based on the Ganga hospital score. Injury 2007; 38: 137-46.

How to Cite this article: Agraharam D, Arun Kamal C, Rajasekaran RB, VelMurugesan P, Perumal R, Dheenadhayalan J. Management of Open Injuries: What has changed. Trauma International May -Aug 2018;4(1):7-11.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Skeletal Stabilization In Open Injuries

Management of Open Injuries: What has changed?

Skeletal Stabilization In Open Injuries

Management of Open Injuries: What has changed?

Full Sized Blog Element (Big Preview Pic)

Skeletal Stabilization In Open Injuries

Author: Dheenadhayalan J [1], Raja Bhaskara Rajasekaran [1], Sivakumar S P [1], Ramesh Perumal [1], Arun Kamal C [1].

Abstract

References

(Abstract Text HTML) (Download PDF)

Management of Open Injuries: What has changed?

Author: Devendra Agraharam [1], Arun Kamal C [1], Raja Bhaskara Rajasekaran [1], Vel Murugesan P [1], Ramesh Perumal [1], Dheenadhayalan J [1].

Abstract

References

(Abstract Text HTML) (Download PDF)

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