Abstract
The successful management of open fractures with high infection (<50 %) and non-union rate is a difficult clinical task. In the last decade new biological methods (biologics) have been invented, assisting the modern trauma surgeon in the treatment of open fractures. In this article we provide an overview of the recent management algorithms and individual treatment options for open fractures. Beside management of infection and associated complications, we focus on the late complications, non-unions and bone segmental defects, and their management. Commercially available bone grafts and growth factors are discussed, summarized and future perspectives mentioned.
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References
Schmidmaier G, Lucke M, Wildemann B, Haas NP, Raschke M (2006) Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review. Injury 37(Suppl 2):S105–S112
Court-Brown CM, Rimmer S, Prakash U, McQueen MM (1998) The epidemiology of open long bone fractures. Injury 29:529–534
Schwabe P, Haas NP, Schaser KD (2010) Fractures of the extremities with severe open soft tissue damage. Initial management and reconstructive treatment strategies. Unfallchirurg 113:647–670; quiz 671–672
Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, Sanders RW, Jones AL, McAndrew MP, Patterson BM, McCarthy ML, Travison TG, Castillo RC (2002) An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med 347:1924–1931
Taitsman LA, Lynch JR, Agel J, Barei DP, Nork SE (2009) Risk factors for femoral nonunion after femoral shaft fracture. J Trauma 67:1389–1392
Davies AM, Grimer R (2005) The penumbra sign in subacute osteomyelitis. Eur Radiol 15:1268–1270
Davies AM, Hughes DE, Grimer RJ (2005) Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis. Eur Radiol 15:2194–2199
Gustilo RB, Merkow RL, Templeman D (1990) The management of open fractures. J Bone Joint Surg Am 72:299–304
Court-Brown CM, Wheelwright EF, Christie J, McQueen MM (1990) External fixation for type III open tibial fractures. J Bone Joint Surg Br 72:801–804
Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458
Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746
Lenarz CJ, Watson JT, Moed BR, Israel H, Mullen JD, Macdonald JB (2010) Timing of wound closure in open fractures based on cultures obtained after debridement. J Bone Joint Surg Am 92:1921–1926
Seligson D, Ostermann PA, Henry SL, Wolley T (1994) The management of open fractures associated with arterial injury requiring vascular repair. J Trauma 37:938–940
Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr (2004) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 18:S32–S38
Kanakaris NK, Morell D, Gudipati S, Britten S, Giannoudis PV (2011) Reaming irrigator aspirator system: early experience of its multipurpose use. Injury 42(Suppl 4):S28–S34
Webb LX, Pape HC (2008) Current thought regarding the mechanism of action of negative pressure wound therapy with reticulated open cell foam. J Orthop Trauma 22:S135–S137
Stannard JP, Volgas DA, Stewart R, McGwin G Jr, Alonso JE (2009) Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma 23:552–557
Gosselin RA, Roberts I, Gillespie WJ (2004) Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev:CD003764
Gosselin A, Hare L (2004) Effect of sedimentary cadmium on the behavior of a burrowing mayfly (Ephemeroptera, Hexagenia limbata). Environ Toxicol Chem 23:383–387
Patzakis MJ, Wilkins J (1989) Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res 243:36–40
Darley ES, MacGowan AP (2004) Antibiotic treatment of gram-positive bone and joint infections. J Antimicrob Chemother 53:928–935
Kawashima M, Tamura H, Nagayoshi I, Takao K, Yoshida K, Yamaguchi T (2004) Hyperbaric oxygen therapy in orthopedic conditions. Undersea Hyperb Med 31:155–162
Knaepler H (2012) Local application of gentamicin-containing collagen implant in the prophylaxis and treatment of surgical site infection in orthopaedic surgery. Int J Surg 10(Suppl 1):S15–S20
Lovering AM, Sunderland J (2012) Impact of soaking gentamicin-containing collagen implants on potential antimicrobial efficacy. Int J Surg 10(Suppl 1):S2–S4
Ostermann PA, Henry SL, Seligson D (1993) Value of adjuvant local antibiotic administration in therapy of open fractures. A comparative analysis of 704 consecutive cases. Langenbecks Arch Chir 378:32–36
Masquelet AC, Fitoussi F, Begue T, Muller GP (2000) Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet 45:346–353
Giannoudis PV, Dinopoulos H, Tsiridis E (2005) Bone substitutes: an update. Injury 36(Suppl 3):S20–S27
Retzepi M, Donos N (2010) Guided bone regeneration: biological principle and therapeutic applications. Clin Oral Implants Res 21:567–576
Skaggs DL, Samuelson MA, Hale JM, Kay RM, Tolo VT (2000) Complications of posterior iliac crest bone grafting in spine surgery in children. Spine 25:2400–2402
Niedhart C, Pingsmann A, Jurgens C, Marr A, Blatt R, Niethard FU (2003) Complications after harvesting of autologous bone from the ventral and dorsal iliac crest – a prospective, controlled study. Z Orthop Ihre Grenzgeb 141:481–486
Schmidmaier G, Herrmann S, Green J, Weber T, Scharfenberger A, Haas NP, Wildemann B (2006) Quantitative assessment of growth factors in reaming aspirate, iliac crest, and platelet preparation. Bone 39:1156–1163
Bacher A, Mayer N, Klimscha W, Oismuller C, Steltzer H, Hammerle A (1997) Effects of pentoxifylline on hemodynamics and oxygenation in septic and nonseptic patients. Crit Care Med 25:795–800
Berven S, Tay BK, Kleinstueck FS, Bradford DS (2001) Clinical applications of bone graft substitutes in spine surgery: consideration of mineralized and demineralized preparations and growth factor supplementation. Eur Spine J 10(Suppl 2):S169–S177
Blokhuis TJ, Lindner T (2008) Allograft and bone morphogenetic proteins: an overview. Injury 39(Suppl 2):S33–S36
Griffin XL, Wallace D, Parsons N, Costa ML (2012) Platelet rich therapies for long bone healing in adults. Cochrane Database Syst Rev 7:CD009496
Kasten P, Vogel J, Geiger F, Niemeyer P, Luginbuhl R, Szalay K (2008) The effect of platelet-rich plasma on healing in critical-size long-bone defects. Biomaterials 29:3983–3992
Schmidmaier G, Schwabe P, Wildemann B, Haas NP (2007) Use of bone morphogenetic proteins for treatment of non-unions and future perspectives. Injury 38(Suppl 4):S35–S41
Lissenberg-Thunnissen SN, de Gorter DJ, Sier CF, Schipper IB (2011) Use and efficacy of bone morphogenetic proteins in fracture healing. Int Orthop 35:1271–1280
Brown KV, Li B, Guda T, Perrien DS, Guelcher SA, Wenke JC (2011) Improving bone formation in a rat femur segmental defect by controlling bone morphogenetic protein-2 release. Tissue Eng Part A 17:1735–1746
Kanakaris NK, Lasanianos N, Calori GM, Verdonk R, Blokhuis TJ, Cherubino P, De Biase P, Giannoudis PV (2009) Application of bone morphogenetic proteins to femoral non-unions: a 4-year multicentre experience. Injury 40(Suppl 3):S54–S61
Fuchs T, Stange R, Schmidmaier G, Raschke MJ (2011) The use of gentamicin-coated nails in the tibia: preliminary results of a prospective study. Arch Orthop Trauma Surg 131:1419–1425
Schnoke M, Midura RJ (2007) Pulsed electromagnetic fields rapidly modulate intracellular signaling events in osteoblastic cells: comparison to parathyroid hormone and insulin. J Orthop Res 25:933–940
Victoria G, Petrisor B, Drew B, Dick D (2009) Bone stimulation for fracture healing: what’s all the fuss? Indian J Orthop 43:117–120
Ciombor DM, Aaron RK (2005) The role of electrical stimulation in bone repair. Foot Ankle Clin 10:579–593, vii
Hannouche D, Petite H, Sedel L (2001) Current trends in the enhancement of fracture healing. J Bone Joint Surg Br 83:157–164
Kuzyk PR, Schemitsch EH (2009) The science of electrical stimulation therapy for fracture healing. Indian J Orthop 43:127–131
Midura RJ, Ibiwoye MO, Powell KA, Sakai Y, Doehring T, Grabiner MD, Patterson TE, Zborowski M, Wolfman A (2005) Pulsed electromagnetic field treatments enhance the healing of fibular osteotomies. J Orthop Res 23:1035–1046
Boyette MY, Herrera-Soto JA (2012) Treatment of delayed and nonunited fractures and osteotomies with pulsed electromagnetic field in children and adolescents. Orthopedics 35:e1051–e1055
Assiotis A, Sachinis NP, Chalidis BE (2012) Pulsed electromagnetic fields for the treatment of tibial delayed unions and nonunions. A prospective clinical study and review of the literature. J Orthop Surg Res 7:24
Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH (2001) Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma 51:693–702; discussion 702–703
Rutten S, Nolte PA, Guit GL, Bouman DE, Albers GH (2007) Use of low-intensity pulsed ultrasound for posttraumatic nonunions of the tibia: a review of patients treated in the Netherlands. J Trauma 62:902–908
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Kleber, C., Haas, N.P. (2013). Biologics in Open Fractures. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 13. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36149-4_6
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DOI: https://doi.org/10.1007/978-3-642-36149-4_6
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