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Le fratture esposte articolari e periarticolari

  • Vincenzo CirielloEmail author
  • Alberto Combi
  • Roberto Chiarpenello
  • Lucio Piovani
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Articular and periarticular open fractures

Abstract

Exposed articular and periarticular fractures are serious injuries, often resulting from high-energy traumas, associated to high risk of septic complications, functional impairment of the affected limb and not infrequently patient’s life threatening conditions. Their incidence, though low, is however increasing.

The patient with exposed fracture presents an associated injury up to one third of cases. The initial evaluation plays a fundamental role both in the identification and treatment of any concomitant injuries, and in the choice of strategy and timing of treatment of the exposed fractures. The presence of a plastic surgeon in the team facilitates the definition of the therapeutic path.

The debridement of the lesion is a fundamental time and must be accurate. Stabilization with external fixator is certainly the treatment of choice and can be adopted both as temporary or as a definitive fixation. Soft tissue management is the keystone of the therapeutic pathway of exposed articular and periarticular fractures. The progress made in “orthoplasty” encourages acute internal fixation and immediate coverage—fix and flap, with a significant reduction in infectious risks and improvement of prognosis.

In any case, the available evidence about the treatment of these injuries is limited. Proper management requires a multidisciplinary approach, great experience and personalization of the therapeutic path.

Notes

Conflitto di interesse

Gli autori V. Ciriello, A. Combi, R. Chiarpenello e L. Piovani dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and Animal Rights

L’articolo non contiene alcuno studio eseguito su esseri umani e su animali da parte degli autori.

Bibliografia

  1. 1.
    Court-Brown CM, Rimmer S, Prakash U et al. (1998) The epidemiology of open long bone fractures. Injury 29:529–534 CrossRefPubMedGoogle Scholar
  2. 2.
    Howard M, Court-Brown CM (1997) Epidemiology and management of open fractures of the lower limb. Br J Hosp Med 57:582–587 PubMedGoogle Scholar
  3. 3.
    Johansen K, Daines M, Howey T et al. (1990) Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 30:568–572 PubMedGoogle Scholar
  4. 4.
    Shanmuganathan R (2008) The utility of scores in the decision to salvage or amputation in severely injured limbs. Indian J Orthop 42:368–376 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rajasekaran S, Naresh Babu J, Dheenadhayalan J et al. (2006) A score for predicting salvage and outcome in Gustilo type-IIIA and type-IIIB open tibial fractures. J Bone Jt Surg Br 88:1351–1360 CrossRefGoogle Scholar
  6. 6.
    Crowley DJ, Kanakaris NK, Giannoudis PV (2007) Irrigation of the wounds in open fractures. J Bone Jt Surg Br 89:580–585 CrossRefGoogle Scholar
  7. 7.
    Gilmore OJ, Sanderson PJ (1975) Prophylactic interparietal povidone-iodine in abdominal surgery. Br J Surg 62:792–799 CrossRefPubMedGoogle Scholar
  8. 8.
    Di Pasquale DJ, Bhandari M, Tov A et al. (2007) The effect of high and low pressure pulsatile lavage on soft tissue and cortical blood flow: a canine segmental humerus fracture model. Arch Orthop Trauma Surg 127:879–884 CrossRefPubMedGoogle Scholar
  9. 9.
    British Orthopaedic Association and British Association of Plastic Surgeons (1993) The early management of severe tibial fractures: the need for combined plastic and orthopaedic management: a report by the BOA/BAPS Working Party on Severe Tibial Injuries. BOA/BAPS, London Google Scholar
  10. 10.
    Crowley DJ, Kanakaris NK, Giannoudis PV (2007) Debridement and wound closure of open fractures: the impact of the time factor on infection rates. Injury 38:879–889 CrossRefPubMedGoogle Scholar
  11. 11.
    Olson SA, Schemitsch EH (2003) Open fractures of the tibial shaft: an update. Instr Course Lect 52:623–631 PubMedGoogle Scholar
  12. 12.
    Hyman J, Moore T (1999) Anatomy of the distal knee joint and pyarthrosis following external fixation. J Orthop Trauma 13:241–246 CrossRefPubMedGoogle Scholar
  13. 13.
    Chapman MW (1980) The use of immediate internal fixation in open fractures. Orthop Clin N Am 11:579–591 Google Scholar
  14. 14.
    Schmidt AH, Swiontkowski MF (2000) Pathophysiology of infections after internal fixation of fractures. J Am Acad Orthop Surg 8:285–291 CrossRefPubMedGoogle Scholar
  15. 15.
    Franklin JL, Johnson KD, Hansen ST (1984) Immediate internal fixation of open ankle fractures. Report of thirty-eight cases treated with a standard protocol. J Bone Jt Surg, Am 66:1349–1356 CrossRefGoogle Scholar
  16. 16.
    Ketenjian AY, Shelton ML (1972) Primary internal fixation of open fractures: a retrospective study of the use of metallic internal fixation in fresh open fractures. J Trauma 12:756–763 PubMedGoogle Scholar
  17. 17.
    Rajasekaran S, Dheenadhayalan J, Babu JN et al. (2009) Immediate primary skin closure in type-III A and B open fractures: results after a minimum of five years. J Bone Jt Surg Br 91:217–224 CrossRefGoogle Scholar
  18. 18.
    Rajasekaran S, Sabapathy SR (2007) A philosophy of care of open injuries based on the Ganga hospital score. Injury 38:137–146 CrossRefPubMedGoogle Scholar
  19. 19.
    Al-Arabi YB, Nader M, Hamidian-Jahromi AR et al. (2007) The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: a 9-year prospective study from a district general hospital. Injury 38:900–905 CrossRefPubMedGoogle Scholar
  20. 20.
    Bhandari M, Guyatt GH, Swiontkowski MF et al. (2001) Treatment of open fractures of the shaft of the tibia. J Bone Jt Surg Br 83:62–68 CrossRefGoogle Scholar
  21. 21.
    Moola F, Jacks D, Reindl R et al. (2008) Safety of primary closure of soft tissue wounds in open fractures. J Bone Jt Surg Br 90-B:94 Google Scholar
  22. 22.
    Patzakis MJ, Bains RS, Lee J et al. (2000) Prospective, randomized, double-blind study comparing single-agent antibiotic therapy, ciprofloxacin, to combination antibiotic therapy in open fracture wounds. J Orthop Trauma 14:529–533 CrossRefPubMedGoogle Scholar
  23. 23.
    Streubel PN, Stinner DJ, Obremskey WT (2012) Use of negative-pressure wound therapy inorthopaedic trauma. J Am Acad Orthop Surg 20:564–574 PubMedGoogle Scholar
  24. 24.
    Gopal S, Majumder S, Batchelor AG et al. (2000) Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Jt Surg Br 82:959–966 CrossRefGoogle Scholar

Copyright information

© Società Italiana Ortopedici Traumatologi Ospedalieri d’Italia 2019

Authors and Affiliations

  • Vincenzo Ciriello
    • 1
    Email author
  • Alberto Combi
    • 1
  • Roberto Chiarpenello
    • 1
  • Lucio Piovani
    • 1
  1. 1.S.O.C. di Ortopedia e TraumatologiaA.O. SS. Croce e CarleCuneoItalia

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