Article information
Abstract
A review is presented on the current status of open fracture treatments, and an attempt is made to clear up controversies and establish the basic principles of their current treatment.
The use of antibiotics in the initial treatment of open fractures is a well known concept, and the earlier they are given the greater is the reduction in the likelihood of infection. The more radical the debridement is, the lower the rate of infection. The fixation method of choice for open fractures of the diaphysis of the leg is the intramedullary nail. The use of external fixation should be limited to cases of multiple traumas. If the debridement has been exhaustive, a better result is obtained with the primary closure of the wound. The loss of soft tissue must be repaired as soon as possible and using the simplest but most efficient system on the orthoplastic ladder; secondary closure, free graft, rotational flap, free microvascularised flap.
Although some treatment guidelines are clear, each open fracture is different and must be adapted to each fracture and to each patient.
Keywords:
Open fracture
Antibiotic
Wound
Tibia
Intramedullary nail
Resumen
Se presenta una revisión del estado actual del tratamiento de las fracturas abiertas. Procurando despejar controversias y establecer los principios básicos de su tratamiento actual.
El empleo de antibióticos en el tratamiento inicial de las fracturas abiertas es un concepto bien establecido, cuanto más precoz es su administración mayor es la reducción de la posibilidad de infección. Cuanto más radical es el desbridamiento, menor es la tasa de infección. El método de fijación de elección para las fracturas abiertas de las diáfisis de la extremidad inferior es el enclavado endomedular. El uso de fijadores externos debería limitarse a los casos de politraumatismos. Si el desbridamiento ha sido exhaustivo, se obtiene un mejor resultado con el cierre primario de la herida. Se debe reparar la pérdida de partes blandas tan pronto como sea posible y mediante el uso del sistema más simple pero eficaz en la escalera ortoplástica: cierre secundario, injerto libre, colgajo rotacional, colgajo libre microvascularizado.
Aunque algunas pautas de tratamiento son claras, cada fractura abierta es distinta por lo cual el tratamiento debe ajustarse a cada fractura y a cada paciente.
Palabras clave:
Fractura abierta
Antibiótico
Herida
Tibia
Clavo endomedular
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