Trauma

Trauma questions and answers

Trauma-live-9172018

 

Table of Contents

Prevention — Page:6

Host Factors– Page:7

  • Question 1: What is the relationship between smoking and infection in fracture procedures? Is smoking history or only current smoking important? — Page: Does nicotine cessation at time of fracture reduce complication rates? — Page:8
  • Question 2: What is the role of nutritional supplementation in avoiding infection in acute fracture cases? — Page:13
  • Question 3: Does preoperative pneumonia/UTI/ trophic ulcers increase PJI/SSI risk in femoral neck fracture patients treated by partial/ total hip arthroplasty? — Page:17
  • Question 4: Are there microorganism specific risk factors for acute infection in trauma patients (i.e., Does being a nasal carrier of MRSA increase the risk for MRSA infection after trauma?) — Page:19
  • Question 5: Is periprosthetic fracture a risk for the development of a PJI? — Page:24
  • Question 6: Are there predictors of the need for allogeneic blood transfusion in arthroplasty for acute hip fractures? — Page:26

Risk Mitigation — Page:30

  • Question 1: Is there a role for bacterial decolonization (for example, of MRSA in nares) in trauma cases? — Page:31
  • Question 2: What are the ideal strategies to prevent secondary and nosocomial contamination of open fracture wounds which are left open? — Page:35
  • Question 3: Is there a difference in the risk of PJI with use of internal versus external fixation for treatment of periprosthetic fractures? — Page:40
  • Question 4: Should definitive fixation of fracture in a polytrauma patient and open abdomen be delayed until the abdomen is closed? — Page:43

Diagnosis — Page:45

  • Question 1: Which open fracture classification system currently used, Gustilo-Anderson or OTA open fracture classification (OTA-OFC), is preferred based on interobserver reproducibility and predictiveness of outcomes? — Page:46
  • Question 2: What diagnostic criteria must be fulfilled to diagnose SSI (surgical site infection) in Orthopedic trauma (including external fixators)? — Page:49
  • Question 3: What diagnostic criteria define infected non-union of long bone? — Page:53
  • Question 4: What differentiates acute from chronic osteomyelitis? Is it clinically important to distinguish one from the other? — Page:61
  • Question 5: Is synovial fluid or fracture hematoma always aseptic? If not, could this play a role in acute infection or PJI after ORIF? — Page:69
  • Question 6: What is the relationship between implanted metal and colonization under a VAC in open fractures? — Page:71

Treatment — Page:74

Antibiotics & Non-operative Management — Page:75

  • Question 1: What is the most optimal prophylaxtic antibiotic coverage and treatment duration for open fractures of long bones? — Page:76
  • Question 2: What antibiotic should be used for low energy open fractures? — Page: What antibiotic(s) should be used for high energy open and grossly contaminated fractures? — Page:81
  • Question 3: What is the optimal mechanism for delivery of local antibiotics in contaminated or infected wounds? — Page:84
  • Question 4: Is there a role for combination of local and systemic antibiotic delivery systems to treat open fractures with overlying contaminated wounds? — Page:89
  • Question 5: What is the most optimal antibiotic treatment for chronic osteomyelitis? — Page:92
  • Question 6: What is the recommended suppressive antibiotic therapy for the treatment of chronic osteomyelitis after fracture fixation while the implant cannot be removed? — Page:97
  • Question 7: Is there a role for hyperbaric oxygen therapy and other non-antibiotic methods for the treatment of chronic osteomyelitis/implant infections? — Page:102

Surgeon & Care Team — Page:105

  • Question 1: Should all infected non-unions be treated in specialized septic surgery centers? — Page:106
  • Question 2: Is there a minimum number of complex osteomyelitis procedures a surgeon should perform annually to ensure proper outcomes? — Page:111
  • Question 3: Who are the essential members of the multidisciplinary team required to manage infected fractures and non-unions? — Page:113

Risk Factors — Page:117

  • Question 1: What are predictors of the need for allogeneic blood transfusion in periprosthetic fractures? — Page:118
  • Question 2: Is acute femoral neck fracture a risk factor for infection in patients undergoing hip arthroplasty? — Page:121

Procedure-Related — Page:123

  • Question 1: What is the optimal timing of surgical debridement in open fractures? — Page:124
  • Question 2: What is the recommended volume of irrigating fluid in the ED for open fractures? — Page:127
  • Question 3: What is the recommended volume and composition of irrigating fluid in the OR for open fractures and post-traumatic wounds? — Page:130
  • Question 4: What is the most appropriate management of early (prior to complete wound healing) infection after fracture fixation with stable fixation? — Page:134
  • Question 5: What is the most appropriate management of early (before complete wound healing) infection after fracture fixation with unstable fixation? — Page:139
  • Question 6: What is the appropriate timing of conversion to internal fixation following external fixation? How is this altered by pin site infection? — Page:143
  • Question 7: What are the alternatives to segmental resection in septic non-union? — Page:147
  • Question 8: What is the optimal management (Masquelet technique, bone transfer) of post-infective bone defects in different long bones (tibia, femur, humerus, etc.)? How does this vary by type of defect (conical vs. cylindrical)? — Page:157
  • Question 9: What is the optimum waiting time for bone grafting in staged management of septic nonunion? — Page:167

Management of Hardware — Page:174

  • Question 1: When should hardware be removed when treating SSI (surgical site infection) in Orthopedic trauma? — Page:175
  • Question 2: Which surgical treatment (plate, nail, external fixator) for open tibial shaft fractures results in lower rate of infection? — Page:180
  • Question 3: When performing intramedullary fixation, what is the evidence regarding reaming versus non-reaming and association with infection? — Page:188
  • Question 4: Are antibiotic-coated rods and plates an acceptable alternative to cement only implants? — Page:191
  • Question 5: What is the ideal composition of antibiotic-impregnated intramedullary nails? — Page:193
  • Question 6: What is the ideal composition of antibiotic-impregnated spacers/beads in post-traumatic infections? Is preoperative microbial identification necessary? — Page:197
  • Question 7: Should antibiotic cement rods be left permanently in situ? — Page:200

Wound Coverage — Page:202

  • Question 1: Is there evidence to support one type of flap coverage over another (muscle over fasciocutaneous flap, for example) after open tibial fractures? — Page:203
  • Question 3: Should open fracture wounds be closed primarily or closed secondarily? If closed primarily, which ones and under what criteria? — Page:212
  • Question 4: What are the evidence-based recommendations for the use of Negative Pressure Wound Therapy in open fractures and traumatic wounds? — Page:216

Outcomes — Page:221

  • Question 1: What is the most appropriate outcome measurement (clinical, radiographic, laboratory, etc.) for management of early infection after fracture fixation? — Page:222