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[PMID]: 29305456 [Au] Autor: Sprague S; Petrisor B; Jeray K; McKay P; Heels-Ansdell D; Schemitsch E; Liew S; Guyatt G; Walter SD; Bhandari M; FLOW Investigators [Ad] Endereço: McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada. [Ti] Título: Wound irrigation does not affect health-related quality of life after open fractures: results of a randomized controlled trial. [So] Source: Bone Joint J;100-B(1):88-94, 2018 01. [Is] ISSN: 2049-4408 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: AIMS: The Fluid Lavage in Open Fracture Wounds (FLOW) trial was a multicentre, blinded, randomized controlled trial that used a 2 × 3 factorial design to evaluate the effect of irrigation solution (soap normal saline) and irrigation pressure (very low low high) on health-related quality of life (HRQL) in patients with open fractures. In this study, we used this dataset to ascertain whether these factors affect whether HRQL returns to pre-injury levels at 12-months post-injury. PATIENTS AND METHODS: Participants completed the Short Form-12 (SF-12) and the EuroQol-5 Dimensions (EQ-5D) at baseline (pre-injury recall), at two and six weeks, and at three, six, nine and 12-months post-fracture. We calculated the Physical Component Score (PCS) and the Mental Component Score (MCS) of the SF-12 and the EQ-5D utility score, conducted an analysis using a multi-level generalized linear model, and compared differences between the baseline and 12-month scores. RESULTS: We found no clinically important differences between irrigating solutions or pressures for the SF-12 PCS, SF-12 MCS and EQ-5D. Irrespective of treatment, participants had not returned to their pre-injury function at 12-months for any of the three outcomes (p < 0.001). CONCLUSION: Neither the composition of the irrigation solution nor irrigation pressure applied had an effect on HRQL. Irrespective of treatment, patients had not returned to their pre-injury HRQL at 12 months post-fracture. Cite this article: 2018;100-B:88-94. [Mh] Termos MeSH primário: Fraturas Expostas/terapia Qualidade de Vida Irrigação Terapêutica/métodos [Mh] Termos MeSH secundário: Adulto Idoso Feminino Seguimentos Fixação Interna de Fraturas/métodos Fraturas Expostas/reabilitação Seres Humanos Masculino Meia-Idade Pressão Psicometria Sabões/administração & dosagem Cloreto de Sódio/administração & dosagem [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Soaps); 451W47IQ8X (Sodium Chloride) [Em] Mês de entrada: 1801 [Cu] Atualização por classe: 180307 [Lr] Data última revisão: 180307 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180107 [St] Status: MEDLINE [do] DOI: 10.1302/0301-620X.100B1.BJJ-2017-0955.R1

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[PMID]: 29169601 [Au] Autor: Warrender WJ; Lucasti CJ; Chapman TR; Ilyas AM [Ad] Endereço: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. [Ti] Título: Antibiotic Management and Operative Debridement in Open Fractures of the Hand and Upper Extremity: A Systematic Review. [So] Source: Hand Clin;34(1):9-16, 2018 02. [Is] ISSN: 1558-1969 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Open fractures of the hand are thought to be less susceptible to infection than other open fractures because of the increased blood supply to the area. Current evidence for all open fractures shows that antibiotic use and the extent of contamination are predictive of infection risk, but time to debridement is not. We reviewed in a systematic review the available literature on open fractures of the hand and upper extremity to determine infection rates based on the timing of debridement and antibiotic administration. We continue to recommend prompt debridement and treatment of most open fractures of the upper extremity. [Mh] Termos MeSH primário: Antibacterianos/uso terapêutico Desbridamento Fraturas Expostas/cirurgia Traumatismos da Mão/cirurgia Infecção da Ferida Cirúrgica/prevenção & controle [Mh] Termos MeSH secundário: Fixação Interna de Fraturas Seres Humanos Tempo para o Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 180303 [Lr] Data última revisão: 180303 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171125 [St] Status: MEDLINE

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[PMID]: 29169595 [Au] Autor: Iorio ML; Harper CM; Rozental TD [Ad] Endereço: Department of Orthopaedics, Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA. Electronic address: mattiorio@gmail.com. [Ti] Título: Open Distal Radius Fractures: Timing and Strategies for Surgical Management. [So] Source: Hand Clin;34(1):33-40, 2018 02. [Is] ISSN: 1558-1969 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Open distal radius fractures are rare injuries with few studies to guide treatment. Degree of soft tissue injury and contamination may be a primary consideration to dictate timing and operative intervention. Antibiotics should be started as early as possible and include a first-generation cephalosporin. Surgical fixation remains a matter of surgeon preference: although studies support the use of definitive internal fixation, many surgeons address contaminated injuries with external fixation. Although postoperative outcomes are similar to closed injuries for low-grade open distal radius fractures, high-grade injuries with more complex fracture patterns carry a high risk of complications, poor outcomes, and repeat surgical procedures. [Mh] Termos MeSH primário: Fraturas Expostas/cirurgia Fraturas do Rádio/cirurgia [Mh] Termos MeSH secundário: Antibacterianos/uso terapêutico Desbridamento Fixação Interna de Fraturas Fraturas Expostas/classificação Seres Humanos Lesões dos Tecidos Moles/cirurgia Irrigação Terapêutica Tempo para o Tratamento Infecção dos Ferimentos/prevenção & controle [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 180303 [Lr] Data última revisão: 180303 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171125 [St] Status: MEDLINE

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[PMID]: 29169590 [Au] Autor: Tulipan JE; Ilyas AM [Ad] Endereço: Department of Orthopaedic Surgery, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA. Electronic address: jacob.tulipan@gmail.com. [Ti] Título: Open Fractures of the Hand: Review of Pathogenesis and Introduction of a New Classification System. [So] Source: Hand Clin;34(1):1-7, 2018 02. [Is] ISSN: 1558-1969 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Open fractures of the hand are a common and varied group of injuries. Although at increased risk for infection, open fractures of the hand are more resistant to infection than other open fractures. Numerous unique factors in the hand may play a role in the altered risk of postinjury infection. Current systems for the classification of open fractures fail to address the unique qualities of the hand. This article proposes a novel classification system for open fractures of the hand, taking into account the factors unique to the hand that affect its risk for developing infection after an open fracture. [Mh] Termos MeSH primário: Fraturas Expostas/classificação Fraturas Expostas/cirurgia Traumatismos da Mão/cirurgia Infecção da Ferida Cirúrgica/prevenção & controle [Mh] Termos MeSH secundário: Antibacterianos/uso terapêutico Desbridamento Fixação de Fratura Seres Humanos Infecção da Ferida Cirúrgica/etiologia [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 180303 [Lr] Data última revisão: 180303 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171125 [St] Status: MEDLINE

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[PMID]: 27778039 [Au] Autor: Kamal A; Kanakeshwar RB; Shyam A; Jayaramaraju D; Agraharam D; Perumal R; Rajasekaran S [Ad] Endereço: Department of spine surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India. [Ti] Título: Variation in practice preferences in management of open injuries of extremities-an international survey by SICOT research academy. [So] Source: Int Orthop;41(1):3-11, 2017 Jan. [Is] ISSN: 1432-5195 [Cp] País de publicação: Germany [La] Idioma: eng [Ab] Resumo: PURPOSE: Open fractures are challenging injuries and there is a lot of variation in practice preferences which may reflect the wide variations in outcome in different units across the world. A survey was done amongst the international community of SICOT membership to document the practice preferences and variations. METHODS: An online questionnaire containing 23 questions which were sub-divided into three sections covering the various aspects of open injury management was sent by email to orthopaedic trauma surgeons across the world. A total of 358 responses were evaluated and presented in this manuscript. RESULTS: The SICOT study confirmed wide variation in practice protocols. About 94.7 % of orthopaedic surgeons around the world use the Gustillo Anderson scoring system for assessment of open injury and 50.6 % of surgeons prefer lavage in operation theatre. For lavage, 84.6 % of surgeons preferred normal saline and for antibiotic prophylaxis, 48.3 % used a combination of second generation cephalosporin, metronidazole and an aminoglycoside for a minimum of three to five days. In 88 % of patients, orthopaedic surgeons performed the initial debridement and 69.2 % surgeons aimed for debridement within six hours. Regarding wound management, 43.9 % units preferred and were capable of soft tissue cover within 72 hours and about 26.3 % surgeons combined definitive fixation along with plastic procedure. CONCLUSION: Our study documented wide variations in practice preferences across the world and showed that information and awareness about current guidelines and practices will help many to update themselves in terms of basic questions about open fracture care. [Mh] Termos MeSH primário: Fraturas Expostas/terapia Padrões de Prática Médica/estatística & dados numéricos [Mh] Termos MeSH secundário: Adulto Antibioticoprofilaxia/estatística & dados numéricos Desbridamento/estatística & dados numéricos Feminino Seres Humanos Masculino Inquéritos e Questionários Irrigação Terapêutica/estatística & dados numéricos [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180226 [Lr] Data última revisão: 180226 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161026 [St] Status: MEDLINE [do] DOI: 10.1007/s00264-016-3311-3

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[PMID]: 29437068 [Au] Autor: Ghoshal A; Enninghorst N; Sisak K; Balogh ZJ [Ad] Endereço: John Hunter Hospital, Lookout Road, New Lambton Heights NSW 2305, Australia. [Ti] Título: An interobserver reliability comparison between the Orthopaedic Trauma Association's open fracture classification and the Gustilo and Anderson classification. [So] Source: Bone Joint J;100-B(2):242-246, 2018 Feb. [Is] ISSN: 2049-4408 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: AIMS: To evaluate interobserver reliability of the Orthopaedic Trauma Association's open fracture classification system (OTA-OFC). PATIENTS AND METHODS: Patients of any age with a first presentation of an open long bone fracture were included. Standard radiographs, wound photographs, and a short clinical description were given to eight orthopaedic surgeons, who independently evaluated the injury using both the Gustilo and Anderson (GA) and OTA-OFC classifications. The responses were compared for variability using Cohen's kappa. RESULTS: The overall interobserver agreement was ĸ = 0.44 for the GA classification and ĸ = 0.49 for OTA-OFC, which reflects moderate agreement (0.41 to 0.60) for both classifications. The agreement in the five categories of OTA-OFC was: for skin, ĸ = 0.55 (moderate); for muscle, ĸ = 0.44 (moderate); for arterial injury, ĸ = 0.74 (substantial); for contamination, ĸ = 0.35 (fair); and for bone loss, ĸ = 0.41 (moderate). CONCLUSION: Although the OTA-OFC, with similar interobserver agreement to GA, offers a more detailed description of open fractures, further development may be needed to make it a reliable and robust tool. Cite this article: 2018;100-B:242-6. [Mh] Termos MeSH primário: Fraturas Expostas/classificação [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Idoso de 80 Anos ou mais Criança Feminino Fraturas Expostas/diagnóstico por imagem Fraturas Expostas/cirurgia Seres Humanos Escala de Gravidade do Ferimento Masculino Meia-Idade Variações Dependentes do Observador Estudos Prospectivos Reprodutibilidade dos Testes [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180216 [Lr] Data última revisão: 180216 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180214 [St] Status: MEDLINE [do] DOI: 10.1302/0301-620X.100B2.BJJ-2017-0367.R1

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[PMID]: 29252748 [Au] Autor: Brooks JT; Lee RJ [Ad] Endereço: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland. [Ti] Título: Nonoperative Treatment of a Completely Displaced Pediatric Type-I Open Fracture of the Proximal Part of the Humerus: A Case Report. [So] Source: JBJS Case Connect;6(4):e94, 2016 Oct-Dec. [Is] ISSN: 2160-3251 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: CASE: Most pediatric closed fractures of the proximal part of the humerus are treated nonoperatively. However, with open fractures of the proximal part of the humerus, nonoperative treatment typically is not indicated, and no such cases previously have been reported in the literature. We describe a 10-year-old boy with a completely displaced type-I open fracture of the proximal part of the humerus who was treated definitively in the emergency department with local irrigation and debridement, antibiotics, and the application of a hanging arm cast. One year later, he had complete radiographic union, no infectious sequelae, and no functional impairment of the shoulder. CONCLUSION: Nonoperative treatment of a pediatric type-I open fracture of the proximal part of the humerus can be successful. [Mh] Termos MeSH primário: Fraturas Expostas/terapia Fraturas do Ombro/terapia [Mh] Termos MeSH secundário: Criança Fraturas Expostas/diagnóstico por imagem Seres Humanos Masculino Fraturas do Ombro/diagnóstico por imagem [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180216 [Lr] Data última revisão: 180216 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171219 [St] Status: MEDLINE [do] DOI: 10.2106/JBJS.CC.16.00053

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[PMID]: 29248623 [Au] Autor: Kendall MC; Gorgone M [Ad] Endereço: Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, United States. Electronic address: mark.kendall@lifespan.org. [Ti] Título: Surgical site infection following open reduction and internal fixation of a closed ankle fractures: A retrospective multicenter cohort study. [So] Source: Int J Surg;49:60-61, 2018 01. [Is] ISSN: 1743-9159 [Cp] País de publicação: England [La] Idioma: eng [Mh] Termos MeSH primário: Fraturas do Tornozelo Infecção da Ferida Cirúrgica [Mh] Termos MeSH secundário: Fixação Interna de Fraturas Fraturas Expostas/cirurgia Seres Humanos Redução Aberta Estudos Retrospectivos Fraturas da Tíbia/cirurgia Resultado do Tratamento [Pt] Tipo de publicação: LETTER; COMMENT [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180202 [Lr] Data última revisão: 180202 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171218 [St] Status: MEDLINE

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[PMID]: 29193926 [Au] Autor: Zierenberg García C; Beaton Comulada D; Pérez López JC; Lamela Domenech A; Rivera Ortiz G; González Montalvo HM; Reyes-Martínez PJ [Ti] Título: Acute Shortening and re-lengthening in the management of open tibia fractures with severe bone of 14 CMS or more and extensive soft tissue loss. [So] Source: Bol Asoc Med P R;108(1):89-92, 2016. [Is] ISSN: 0004-4849 [Cp] País de publicação: Puerto Rico [La] Idioma: eng [Ab] Resumo: INTRODUCTION: A traumatic event to the tibia with more than 14 cm of bone and soft tissue loss represents a challenge to most orthopedic surgeons and is considered a limb-threatening condition. Few solutions are available in such clinical situations and among them is the acute shortening and re-lengthening of bone and soft tissue. MATERIALS AND METHODS: Our study presents the management of 7 patients with grade III B open fractures (according to the Gustillo-Anderson classification) of the tibia who underwent resection of all the devitalized tissues, acute limb shortening to close the defect, application of an external fixator, and metaphyseal osteotomy for re-lengthening. The patient outcomes were based on different parameters using the evaluation system established by Paley et al. RESULTS: Results acquired during the study show an average bone loss of 19cm (with a minimum of 14 cm and a maximum of 31.50cm). The average time to full recovery of all patients was 19 months with a minimum of 14 months and a max of 34 months. Patient presented with excellent bony union and none existent or small refractory leg length discrepancy and did not require bone grafts or free flaps. Complications that the patients had were contractures, which required secondary procedures such as Achilles tendon re-lengthening and recurrent infections. DISCUSSION: Overall patients had excellent bone union and were able to perform activities of their daily living. The Ilizarov technique of compression-dis- traction osteogenesis is an elegant treatment option that should be considered in patients suffering such traumatic events providing excellent bony union and good functional outcomes for the patient. [Mh] Termos MeSH primário: Fraturas Expostas/cirurgia Desigualdade de Membros Inferiores/cirurgia Lesões dos Tecidos Moles/etiologia Fraturas da Tíbia/cirurgia [Mh] Termos MeSH secundário: Adolescente Adulto Fixadores Externos Fixação de Fratura/métodos Consolidação da Fratura/fisiologia Seres Humanos Técnica de Ilizarov Desigualdade de Membros Inferiores/etiologia Osteotomia/métodos Recuperação de Função Fisiológica Lesões dos Tecidos Moles/patologia Fraturas da Tíbia/complicações Fatores de Tempo Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171214 [Lr] Data última revisão: 171214 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171202 [St] Status: MEDLINE

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[PMID]: 29068940 [Au] Autor: Stranix JT; Lee ZH; Jacoby A; Anzai L; Avraham T; Thanik VD; Saadeh PB; Levine JP [Ad] Endereço: New York, N.Y. From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center; and the Division of Plastic Surgery, Department of Surgery, Mount Sinai Health System. [Ti] Título: Not All Gustilo Type IIIB Fractures Are Created Equal: Arterial Injury Impacts Limb Salvage Outcomes. [So] Source: Plast Reconstr Surg;140(5):1033-1041, 2017 Nov. [Is] ISSN: 1529-4242 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Open tibia fractures are commonly stratified by the Gustilo classification, an orthopedic grading system that does not incorporate the presence of arterial injury when limb perfusion is intact. In the authors' experience, however, the presence of arterial injury appears to negatively impact microsurgical outcomes. METHODS: In a retrospective review of 806 lower extremity reconstructions between 1979 and 2016, 361 soft-tissue flaps performed for Gustilo type IIIB/C coverage met inclusion criteria. Patient demographics, flap characteristics, and outcomes were analyzed. RESULTS: Most patients suffered type IIIB [n = 332 (91.9 percent)] injuries; 29 (8.0 percent) had type IIIC injuries. Preoperative angiography [n = 243 (67.3 percent)] demonstrated arterial injury in 126 (51.8 percent); 27 arterial injuries were identified intraoperatively; and the overall incidence was 153 of 361 (42.4 percent). Complications occurred in 143 flaps (39.6 percent) and included 37 partial losses (10.2 percent) and 31 total losses (8.6 percent). Injured recipient arteries [n = 62 (17.2 percent)] had more complications (p = 0.004); specifically, increased take-backs (p = 0.009). Decreasing vessel runoff increased the risk of complications (p = 0.025), take-backs (p = 0.007), and total flap failures (p = 0.024) accordingly. Specifically, among grade IIIB injuries, controlling for age, sex, time since injury, and vein number, single-vessel runoff was associated with higher rates of complications (relative risk, 3.07; p = 0.012), take-backs (relative risk, 3.43; p = 0.013), and total flap failures (relative risk, 4.80; p = 0.010) compared with three-vessel runoff. CONCLUSIONS: Arterial injury was common among Gustilo type IIIB patients and correlated with increased reconstructive complications. Nonischemic arterial injury appears to negatively impact reconstructive outcomes and should be accounted for when considering free tissue transfer for lower extremity salvage. The authors propose a 3-2-1 modification of the Gustilo type IIIB classification to incorporate degree of arterial injury, as it appears to add prognostic value and certainly influences the reconstructive plan. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV. [Mh] Termos MeSH primário: Artérias/lesões Fíbula/lesões Fraturas Expostas/cirurgia Retalhos de Tecido Biológico/transplante Salvamento de Membro Fraturas da Tíbia/cirurgia Lesões do Sistema Vascular/cirurgia [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Idoso de 80 Anos ou mais Artérias/cirurgia Criança Feminino Fraturas Expostas/complicações Fraturas Expostas/diagnóstico Seres Humanos Traumatismos da Perna/diagnóstico Traumatismos da Perna/cirurgia Masculino Meia-Idade Artéria Poplítea/lesões Artéria Poplítea/cirurgia Complicações Pós-Operatórias/epidemiologia Complicações Pós-Operatórias/etiologia Estudos Retrospectivos Artérias da Tíbia/lesões Artérias da Tíbia/cirurgia Fraturas da Tíbia/complicações Fraturas da Tíbia/diagnóstico Índices de Gravidade do Trauma Resultado do Tratamento Lesões do Sistema Vascular/complicações Lesões do Sistema Vascular/diagnóstico Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171113 [Lr] Data última revisão: 171113 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171026 [St] Status: MEDLINE [do] DOI: 10.1097/PRS.0000000000003766

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