Infection and Nonunion Rates in Open Fractures: Description of 6,042 Fractures from the FLOW and PREP-IT Trials.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosure: The Aqueous-PREP study was funded by the US Department of Defense (W81XWH-17-1-070), a Canadian Institutes of Health Research Foundation Grant, McMaster University Surgical Associates, and the PSI (Physicians’ Services Incorporated) Foundation. The PREPARE trial was funded by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research. Research reported in this publication was also partially supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 2K24AR076445. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The FLOW trial was supported by research grants from the Canadian Institutes of Health Research (MCT-93173), United States Army Institute of Surgical Research, Orthopaedic Trauma Research Program (OTRP) and Peer Reviewed Orthopaedic Research Program (PRORP), and Association Internationale pour l’Ostéosynthèse Dynamique (AIOD). Stryker provided Surgilav irrigators for the trial for clinical sites in Asia. Zimmer provided Pulsavac irrigators at discounted rates to selected clinical sites in North America. Triad Medical donated the initial supply of castile soap for the study. The FLOW trial was also supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Orthopaedic Trauma Research Program under Award W81XWH-08-1-0473 and the Peer Reviewed Orthopaedic Research Program under Award W81XWH-12-1-0530. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I840). 9. Cureus. 2021 Mar 15;13(3):e13903. doi: 10.7759/cureus.13903. Open Supracondylar Humerus Fractures in Children. Pan T(1), Widner MR(1), Chau MM(2), Hennrikus WL(3). Author information: (1)Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, USA. (2)Department of Orthopaedic Surgery, University of Minnesota Twin Cities, Minneapolis, USA. (3)Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, USA. PURPOSE: Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluate the treatment and outcomes of open SCH fractures in children. METHODS: Between 2008 and 2015, four children (1%) had open injuries among 420 treated for SCH fractures at a single center. The mean patient age was six years (range, four to eight years). Two patients had Gustilo-Anderson grade 1 open fractures and two had grade 2 fractures. Tetanus immunization was up-to-date in all. First dose of intravenous antibiotics was given on average 3hr 7min after onset of injury (range, 1hr 38min to 8hr 15min). Time from injury to irrigation and debridement (I&D) and closed reduction and percutaneous pinning (CRPP) was on average 8hr 16min (range, 4hr 19min to 13hr 15min). All patients received 24-hour intravenous antibiotics. Pins were removed at four weeks and bony union occurred by six weeks. RESULTS: After an average follow-up period of 12 months (range, 6 to 22 months), there were no infections, neurovascular deficits, compartment syndromes, cubitus varus deformities, or range of motion losses. All outcomes were excellent according to the Flynn criteria. Due to the unstable nature of open SCH fractures, a medial pin was used in all four cases. No loss of reduction or ulnar nerve injury occurred. CONCLUSION:  Open injuries occur in approximately 1% of all SCH fractures in children. The authors recommend urgent intravenous antibiotics, I&D, and CRPP involving a medial pin to treat open SCH fractures. Excellent outcomes based on the Flynn criteria were obtained in four cases. Copyright © 2021, Pan et al. DOI: 10.7759/cureus.13903 PMCID: PMC8046429