Objective: The purpose of this study was to investigate different treatment methods employed by orthopedic surgeons for open tibial fracture in adults.Methods: Survey of 12 questions regarding treatment of open tibial fracture was conducted with 285orthopedics and traumatology specialists in Turkey in personal interviews and using web-basedtechnique.Results: Of all survey participants, 99.6% responded that tetanus prophylaxis is necessary emergencyprocedure in cases of adult open tibial diaphysis fracture. In addition, 96.5% considered antibioticsadministration necessary, 85.6% also selected irrigation with saline, 55.4% included debridement, and45.3% temporaryŞxation. Only 4 (1.3%) respondents did not use aminoglycoside antibiotics. While 29.8%of those surveyed preferred externalŞxator as a deŞnitive treatment method, 75.8% use intramedullarynail and 13.7% preferred plate method.Conclusion: A wide variation was observed among orthopedics and traumatology specialists in Turkeyregarding treatment of open tibial diaphysis fracture in adults. Data obtained from this study togetherwith the available literature may be useful to further develop therapeutic approaches.© 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
___
Schenker ML, Ahn J, Donegan D, Mehta S, Baldwin KD. The cost of after-hours operative debridement of open tibia fractures. J Orthop Trauma. 2014;28(11): e631.
Schenker ML, Yannascoli S, Baldwin DK, Ahn J, Mehta S. Does timing to oper- ative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Jt Surg Am. 2012;94(12):1057e1064.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-Şve open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am. 1976;58(4):453e458.
Kamu hastaneleri istatistik yıllı gı. Available at: 2014:46e47. www.tkhk.gov.tr/ dosyalar/b4a241a4aab04c26bdf3def6d2f084e2.pdf.
Helfet DL, Howey T, Sanders R, Johansen K. Limb salvage versus amputation. Preliminary results of the mangled extremity severity score. Clin Orthop Relat Res. 1990;256:80e86.
Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36e40.
Lack WD, Karunakar MA, Angerame MR, Seymour RB, Sims S, Kellam JF. Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. J Orthop Trauma. 2015;29(1):1e6.
Weber D, Dulai SK, Bergman J, Buckley R, Beaupre LA. Time to initial operative treatment following open fracture does not impact development of deep infection: a prospective cohort study of 736 subjects. J Orthop Trauma. ;28(11):613e619.
Farnworth E, Roberts A, Rangaraj A, Minhas U, Holloway S, Harding K. Tetanus in patients with chronic wounds-are we aware? Int Wound J. 2012;9(1):93e99.
World Health Organisation. Prevention and management of wound infection. Available at: http://www.who.int/hac/techguidance/tools/guidelines_prevent ion_and_management_wound_infection.pdf. Bhandari M, Adili A, Schemitsch EH. The efŞcacy of low-pressure lavage with different irrigating solutions to remove adherent bacteria from bone. J Bone Jt Surg Am. 2001;83-A(3):412e419.
Flow investigators. Fluidrot Lavage of Open Wounds (FLOW): design and rationale for a large, multicenter collaborativen 2*3 factorial trial of irrigating pressures and solutions in patients with open fractures. BMC Musculoskelet Disord. 2010;11:11e85.
Miller MD, Thompson SR, Hart JA, eds. Review of Orthopaedics. 6th ed. Elsevier Saunders; 2012:701e702 Chapter 11: Trauma; Weiss DB, Milewski MD,
Thompson SR, Stannard JP. Kindsfater K, Jonassen EA. Osteomyelitis in grade II and III open tibia fractures with late debridement. J Orthop Trauma. 1995;9(2):121e127.
Hospenthal DR, Murray CK, Andersen RC, et al. Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma. 2011;71(2 Suppl 2):S210eS234.
Hauser CJ, Adams Jr CA, Eachempati SR. Surgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline. Surg Infect (Larchmt). 2006;7(4):379e405.
Obremskey W, Molina C, Collinge C, et al. Current practice in the management of open fractures among orthopaedic trauma surgeons. Part A: initial man- agement. A survey of orthopaedic trauma surgeons. J Orthop Trauma. ;28(8):198e202.
Luchette FA, Bone LB, Born CT, et al. EAST practice management guidelines work group: practice management guidelines for prophylactic antibiotic use in open fractures. Available at: http://www.east.org/tpg/.openfrac.pdf. Accessed February 2013.
Rello J, Ausina V, Ricart M, Castella J, Prats G. Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest. 1993;104:1230e1235.
Koulenti D, Rello J. Hospital-acquired pneumonia in the 21st century: a review of existing treatment options and their impact on patient care. Expert Opin Pharmacother. 2006;7:1555e1569.
Rello J, Sa-Borges M, Correa H, Leal SR, Baraibar J. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Respir Crit Care Med. 1999;160(2): e613.
Bach AW, Hansen Jr ST. Plates versus externalŞxation in severe tibial shaft fractures. A randomized trial. Clin Orthop Relat Res. 1989;241:89e94.
Edwards CC, Simmons SC, Browner BD, Weigel MC. Severe open tibial fractures. Results treating 202 injuries with externalŞxation. Clin Orthop Relat Res. ;230:98e115.
Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swionkowski MF. Treatment of type II, IIIA and IIIB open fractures of the tibial shaft: a pro- spective comparison of unreamed interlocking intramedullary nails and half- pin externalŞxators. J Orthop Trauma. 1998;12(1):1e7.
Schandelmaier P, Krettek C, Rudolf J, Tscherne H. Outcome of tibial shaft fractures with severe soft tissue injury treated by unreamed nailing versus externalŞxation. J Trauma. 1995;39(4):707e711.
Kakar S, Tornetta III P. Open fractures of the tibia treated by immediate intramedullary tibial nail insertion without reaming: a prospective study. J Orthop Trauma. 2007;21(3):153e157.
Finkemeier CG,SchmidtAH, KyleRF, TemplemanDC,Varecka TF. A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma. 2000;14(3):187e193.
Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. J Bone Jt Surg Br. 2001;83(1):62e68.
Study of Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Bhandari M, Guyatt G, Tornetta III P, et al. Randomised trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Jt Surg Am. 2008;90(12):2567e2578.
Sheean AJ, Krueger CA, Napierala MA, Stinner DJ, Hsu JR. Skeletal trauma research consortium (STReC). Evaluation of the mangled extremity severity Score in combat-related type III open tibia fracture. J Orthop Trauma. ;28(9):523e526.
Bosse MJ, McCarthy ML, Jones AL, et al. Lower Extremity Assessment Project (LEAP) Study Group.The insensate foot following severe lower extremity trauma: an indication for amputation? J Bone Jt Surg Am. 2005;87(12): e2608.
Obremskey W, Molina C, Collinge C, et al. Current practice in the management of open fractures among orthopaedic trauma surgeons. Part B: management of segmental long bone defects. A survey of orthopaedic trauma association members. J Orthop Trauma. 2014;28(8):203e207.