Journal article
Clinical practice in prevention of fracture-related infection: An international survey among 1197 orthopaedic trauma surgeons.
- Puetzler J Department of Trauma Surgery, University Hospital of Münster, Germany.
- Zalavras C Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
- Moriarty TF AO Research Institute Davos, Switzerland.
- Verhofstad MHJ Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
- Kates SL Department of Orthopaedic Surgery, Virginia Commonwealth University, USA.
- Raschke MJ Department of Trauma Surgery, University Hospital of Münster, Germany.
- Rosslenbroich S Department of Trauma Surgery, University Hospital of Münster, Germany.
- Metsemakers WJ Department of Trauma Surgery, University Hospitals Leuven, Belgium. Electronic address: willem-jan.metsemakers@uzleuven.be.
- 2019-04-29
Published in:
- Injury. - 2019
Fracture-related infection
Guidelines
Infection prevention
Open fracture
Perioperative antibiotic prophylaxis
Questionnaire
Survey
Antibiotic Prophylaxis
Debridement
Fractures, Open
Health Services Research
Humans
Orthopedic Surgeons
Practice Patterns, Physicians'
Surgical Wound Infection
Therapeutic Irrigation
English
INTRODUCTION
Open fractures are still a challenge in orthopaedic trauma surgery, and compared to closed fractures, the rate of complications including fracture-related infection (FRI) remains significantly higher. Although different guidelines on prevention of FRI have been published in past decades, the current recommendations vary significantly. The objectives of this international questionnaire were to evaluate clinical practice procedures for the prevention of FRI in open fractures and to evaluate adherence to available guidelines.
METHODS
A 17-item questionnaire regarding prophylaxis against infection in fracture care was administered by SurveyMonkey® and was sent via blast e-mail to all users of AOTrauma (Davos, Switzerland).
RESULTS
Overall, 1197 orthopaedic trauma surgeons answered the survey. Although cephalosporins were the most commonly prescribed agents for perioperative antibiotic prophylaxis (PAP) in open fractures, a total of 13 different antibiotics were mentioned in the survey. Furthermore, the duration of PAP was extremely variable with a tendency towards longer treatment periods with increasing open fracture severity. The majority of surgeons (71%) agreed that the optimal duration of PAP was not well defined in the literature. The use of local anti-infective agents varied significantly, although all options received additional votes with increasing injury severity. Some of the other surgical aspects addressed in this review were associated with debridement and irrigation. A delay of six hours from injury to the first debridement was acceptable to 47% of surgeons, but delays were tolerable. Normal saline was the solution used most often for wound irrigation in open fractures (89%), with low-pressure irrigation being applied most commonly (55%).
CONCLUSIONS
This international survey provided an overview of clinical practice in FRI prevention, particularly in open fracture cases. The treatment of these serious injuries remains heterogeneous. A major issue is the lack of consensus concerning type and duration of PAP. Furthermore, there seems to be no agreement on the indication for the use of local anti-infective agents. Overall, it is unknown what the repercussions are of this lack of internationally accepted guidelines on daily clinical practice, but it is clear that standardised treatment protocols are preferable in the current medical landscape.
Open fractures are still a challenge in orthopaedic trauma surgery, and compared to closed fractures, the rate of complications including fracture-related infection (FRI) remains significantly higher. Although different guidelines on prevention of FRI have been published in past decades, the current recommendations vary significantly. The objectives of this international questionnaire were to evaluate clinical practice procedures for the prevention of FRI in open fractures and to evaluate adherence to available guidelines.
METHODS
A 17-item questionnaire regarding prophylaxis against infection in fracture care was administered by SurveyMonkey® and was sent via blast e-mail to all users of AOTrauma (Davos, Switzerland).
RESULTS
Overall, 1197 orthopaedic trauma surgeons answered the survey. Although cephalosporins were the most commonly prescribed agents for perioperative antibiotic prophylaxis (PAP) in open fractures, a total of 13 different antibiotics were mentioned in the survey. Furthermore, the duration of PAP was extremely variable with a tendency towards longer treatment periods with increasing open fracture severity. The majority of surgeons (71%) agreed that the optimal duration of PAP was not well defined in the literature. The use of local anti-infective agents varied significantly, although all options received additional votes with increasing injury severity. Some of the other surgical aspects addressed in this review were associated with debridement and irrigation. A delay of six hours from injury to the first debridement was acceptable to 47% of surgeons, but delays were tolerable. Normal saline was the solution used most often for wound irrigation in open fractures (89%), with low-pressure irrigation being applied most commonly (55%).
CONCLUSIONS
This international survey provided an overview of clinical practice in FRI prevention, particularly in open fracture cases. The treatment of these serious injuries remains heterogeneous. A major issue is the lack of consensus concerning type and duration of PAP. Furthermore, there seems to be no agreement on the indication for the use of local anti-infective agents. Overall, it is unknown what the repercussions are of this lack of internationally accepted guidelines on daily clinical practice, but it is clear that standardised treatment protocols are preferable in the current medical landscape.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.injury.2019.04.013
- PMID 31029369
- Persistent URL
- https://sonar.ch/global/documents/39366
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