Changing paradigms in the management of Open Injuries

Vol 2 | Issue 2 | July – Dec 2017 | Page 5-10 | Dheenadhayalan Jayaramaraju, Sivakumar SP, Raja Bhaskara Kanakeshwar, Devendra Agraharam, Ramesh Perumal, Arun Kamal C, Rajasekaran Shanmuganathan


Authors: Dheenadhayalan Jayaramaraju [1], Sivakumar SP [1], Raja Bhaskara Kanakeshwar [1], Devendra Agraharam [1], Ramesh Perumal [1], Arun Kamal C [1], Rajasekaran Shanmuganathan [1]

[1] Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, Coimbatore, Tamil Nadu

Address of Correspondence
Dr Raja Bhaskara Kanakeshwar
Ganga Hospital, Coimbatore
Email : rajalibra299@gmail.com


Abstract

Open injuries still pose a major problem 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 aggressive wound debridement followed by early fracture stabilization with early wound closure to achieve bone and soft tissue healing 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.
2. Hoff WS, Reilly PM, Rotondo MF, DiGiacomo JC, and Schwab CW. The importance of the command-physician in trauma resuscitation. The Journal of trauma 1997; 43: 772-7.
3. Lu WH, Kolkman K, Seger M, and Sugrue M. An evaluation of trauma team response in a major trauma hospital in 100 patients with predominantly minor injuries. The Australian and New Zealand journal of surgery 2000; 70: 329-32.
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; discussion 815-6.
5. Initial Management of Open Fractures .(Book Chapter) S. Rajasekaran et al. Rockwood and Green’s Fractures in Adults. Eight 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: Dheenadhayalan J, Sivakumar SP, Kanakeshwar RB, Agraharam D, Perumal R, Arun KC, Rajasekaran S. Changing paradigms in the management of Open Injuries. Journal of Clinical Orthopaedics July-Dec 2017; 2(2): 5-10.

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