Open fractures: evidence-based best practices

Area of Science:

• Orthopaedic Surgery
• Trauma Management
• Infectious Disease Prevention

Background:

• Open fractures pose significant challenges in orthopaedic trauma care.
• Fracture-related infection (FRI) is a major complication, leading to severe functional deficits and increased healthcare burden.
• Effective management strategies are essential to prevent FRI and improve patient outcomes.

Purpose of the Study:

• To provide a practical, evidence-based summary of key strategies for preventing FRI in open fractures.
• To consolidate current best practices for managing open fractures, drawing from a 2022 OTA International Trauma Care Forum symposium.
• To differentiate management strategies for optimal resource and resource-limited settings.

Main Methods:

• Review of evidence-based strategies for open fracture management.
• Consolidation of expert insights from the 2022 OTA International Trauma Care Forum.
• Categorization of prevention strategies into key areas: host factors, antimicrobial prophylaxis, surgical site management, skeletal stability, and soft-tissue coverage.

Main Results:

• Key strategies for FRI prevention include optimizing host factors, appropriate antimicrobial prophylaxis, meticulous surgical site management (skin prep, debridement, irrigation), ensuring skeletal stability, and timely soft-tissue coverage.
• The review addresses strategies applicable to both optimal resource and resource-limited environments.
• Successful FRI prevention requires a multi-faceted approach tailored to individual patient and injury characteristics.

Conclusions:

• Implementing a comprehensive, evidence-based approach to open fracture management is vital for preventing fracture-related infections.
• Optimizing host factors, antimicrobial use, surgical techniques, and wound care are critical components of FRI prevention.
• Tailored strategies are necessary to effectively manage open fractures and reduce infection risks across diverse healthcare settings.