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Current Practice in the Management of Open Fractures Among Orthopaedic Trauma Surgeons. Part B: Management of
William Obremskey1, Cesar Molina, Cory Collinge
1*Orthopaedic Trauma Institute, Vanderbilt University Medical Center, Nashville, TN; †Department of Orthopaedic Surgery, John Peter Smith, Fort Worth, TX; ‡Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA; §Orthopaedic Trauma Service, Florida Orthopaedic Institute and Department of Orthopaedic Surgery, University of South Florida, Tampa, FL; ‖Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN; ¶Department of Orthopaedic Surgery, Scott & White Healthcare, Temple, TX; and **Orthopaedic Trauma and Fracture Service, Hospital of the University of Pennsylvania, Philadelphia, PA.
Objectives:
Treatment of segmental long bone defects is one of the areas of substantial controversy in current orthopaedic trauma. The main purpose of this survey was to determine current practice and practice variation within the Orthopaedic Trauma Association (OTA) membership on this topic.
Design:
Survey.
Setting:
Web-based survey.
Participants:
Three hundred seventy-nine orthopaedic trauma surgeons.
Methods:
A 15-item questionnaire-based study titled "OTA Open Fracture Survey" was constructed. The survey was delivered to all OTA membership categories. Different components of the data charts were used to analyze various aspects of open fracture management, focusing on definitive treatment and materials used for grafting in "critical-sized" segmental bone defects.
Results:
Between July and August 2012, a total of 379/1545 members responded for a 25% response rate. Overall, 89.5% (339/379) of respondents use some sort of antibiotic cement spacer before bone grafting. It was found that 92% of respondents preferred to use some type of autograft at time of definitive grafting of segmental defects. When using a grafting technique, 88% said they used some type of antibiotic cement. Within that context, 60.1% said graft placement should be done at 6 weeks.
Conclusions:
There continues to be substantial variation in the timing of bone graft placement after soft tissue healing and the source and form of graft used. The use of antibiotic cement is common in segmental defects that require delayed bone grafting. Obtaining base-line practice characteristics on controversial topics will help provide a foundation for assessing research needs and, therefore, goals.
Level Of Evidence:
Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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