1 / 19

SEFS 2019 Open fractures? Post it for the morning

Stay informed on the latest evidence regarding open fractures management, including optimal timeliness of debridement and the impact on infection rates. Explore practical insights on trauma room utilization and staffing strategies.

scallas
Download Presentation

SEFS 2019 Open fractures? Post it for the morning

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SEFS 2019Open fractures? Post it for the morning Steven Cherney, MD

  2. Disclosures • None

  3. Historical 6 hour rule • Freidrich guinea pig • Debridement within 6 hours = healthy

  4. What matters most? JOT 2015 • Antibiotic prophylaxis most critical • Time to coverage second

  5. Literature support • Recently, largely no difference in time to debridement • Even up to 24h • Lack et al. 2015

  6. JBJS 2010 • Prognostic Level II • Earlier admission to trauma center matters but OR timing does not

  7. JBJS 2012 • Level III • No difference in infection rates

  8. Systematic review JOT 2016 • No change in infection at 6h mark

  9. JOT 2014 • Prospective, multicenter observational cohort Level I evidence

  10. Duyos et al. JAAOS 2017 • Increased infection rate debridement >24h

  11. Counterpoint • Malhotra et al. • J Trauma Acute Care Surg 2014 • Infection rate increased at 8h cutoff • Level IV

  12. Does open injury severity play a role? • Hull et a. BJJ 2014 • Increased infection rate Type II and III open tibia fractures • No time cutoff

  13. JOT 2014 • Projected increased cost of running ORs at night without obvious benefit • $4 million?

  14. Dedicated Trauma Room • Ricci et al JBJS 2009 • Lower minor complication rate in cases done during the day • Bhattacharyya et al. J Trauma 2006 • Lower complications, lower cost overruns with dedicated trauma room

  15. What about my practice? Trauma room • Staffed and available 7a-5p daily • Leave this time open • “Cold trauma” should be lowest priority in the trauma room- • Inpatients with closed injuries will get bumped • No outpatient surgery admits in the trauma room

  16. My approach • Open fractures excluding vascular injuries can wait • “Contaminated wound” not a deciding factor • Golden rule

  17. Support staff at night • Someone needs to pass instruments • Little ortho experience- (self-fulfilling?) • Poor attitudes • Someone needs to run the C-arm • Best C-arm tech is “on call”, but will then be unavailable in the AM

  18. Caveats: This may not work for you • Trauma room should be available in AM or within 24h for debridement • Trauma room may not be part of your practice • No vascular injury requiring stabilization

  19. Thank You

More Related