Early Definitive Care Is as Effective as Staged Treatment Protocols for Open Ankle Fractures Caused by Rotational Mechanisms: A Retrospective Case–Control Study
| Autor: | Meg Schuurman, Daniel L Peterson, Muhammad T. Padela, Joseph Wilkinson, Rahul Vaidya, Christopher J Kennedy, Andreea Geamanu |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Ankle Fractures Single Center Fracture Fixation Internal Fractures Open 03 medical and health sciences Fixation (surgical) 0302 clinical medicine Clinical Protocols medicine Humans Internal fixation Orthopedics and Sports Medicine Retrospective Studies 030222 orthopedics business.industry Trauma center Case-control study 030208 emergency & critical care medicine General Medicine Evidence-based medicine Surgery Tibial Fractures Treatment Outcome medicine.anatomical_structure Case-Control Studies Cohort Ankle business |
| Zdroj: | Journal of Orthopaedic Trauma. 34:376-381 |
| ISSN: | 0890-5339 |
| DOI: | 10.1097/bot.0000000000001734 |
| Popis: | Objectives To compare immediate internal fixation with primary wound closure to temporary fixation/stabilization with delayed fixation and wound closure protocols for management of open ankle fractures. Design Retrospective case-control study. Setting Level 1 trauma center. Patients Eighty-eight consecutive patients who presented with a Gustilo-Anderson type I, II, or IIIa open ankle fracture to a single center. Intervention Patients were divided into 2 cohorts: either immediate internal fixation with primary wound closure (EARLY) or temporary fixation/stabilization with delayed fixation and wound closure (STAGED) due to practice differences of the attending surgeons. Main outcome measures Infection, length of stay, number and type of operations, and clinical measures. We also assessed the 2 groups with regard to demographics and radiographic classification. Results Overall, incidence of infection was 6 (6.8%) with no significant difference between patients treated with EARLY versus STAGED protocols. The EARLY cohort had a significantly shorter length of hospital stay, fewer number of reoperations but similar clinical outcomes for pain, ambulation, and radiographic evidence of osteoarthritis for patients followed for >12 months. Conclusion Our study showed that early definitive treatment compared with a staged protocol for Gustilo-Anderson type I, II, and IIIa open ankle fractures has similar rates of infection, shorter hospital stay, fewer surgical interventions, and similar clinical outcomes. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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