Treatment of compound fractures

Article Abstract:

A compound fracture occurs when the broken bone breaks through the skin. Even the smallest skin puncture complicates the treatment and outcome of a fracture. Compound fractures have always been considered potentially life-threatening and until this century were routinely treated with amputation of the limb. Today treatment can involve microsurgery, antibiotics and osteosynthesis (mechanical fastening of the ends of the fractured bone). A review is presented of the current methods of treatment and indications for possible new treatments for this serious injury. Early stabilization of the fracture and progressive debridement (removal of dead tissue and debris in the wound) are important in decreasing the risk of complications. Stabilization of open fractures initially is performed by external fixation. These stabilizing devices (pins, clamps and connectors) placed outside of the body constitute a frame that give the bone stability. Less severe injuries (graded by amount of damage to the soft tissue) may be treated with early internal fracture fixation. It is important that the soft tissue be covered as early as possible to prevent infection. The use of system-wide antibiotics given prophylactically, before there is evidence of infection, has significantly decreased the incidence of acute infection and osteomyelitis (bone infection). An additional technique may be used in severe, high-grade fractures; beads of antibiotic, which release extremely high levels of antibiotic, may be placed within the wound itself. Other new approaches include the use of bioelectric stimulators, new synthetic bone graft substitute materials, and microsurgical techniques. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Osteomyelitis, Fracture fixation, Fractures, Open, Fracture repair, Open fractures

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Combined topical and systemic antibiotic prophylaxis in acute appendicitis

Article Abstract:

In cases of acute appendicitis (inflammation of the appendix of the cecum of the intestine) antibiotics are given, usually systemically, to prevent infection. There is some evidence that combined use of both systemic and local administration may have better results than systemic administration alone. In this study of 246 patients with acute appendicitis, one group of 120 patients was given systemic clindamycin prior to surgery; the second group comprised 126 patients who received locally applied ampicillin in addition to the systemic clindamycin. The rate of wound infection in the clindamycin-only group was 13 percent, compared with a 4 percent rate for the two-antibiotic group. The largest difference between the two therapies was seen in patients with perforated or gangrenous appendicitis; Group 1 patients had a 24 percent infection rate for gangrenous and 30 percent for perforated appendicitis, while in Group 2 the rates were 12 and 6 percent, respectively. It is concluded from these results that prophylaxis with a combination of systemic clindamycin and topical ampicillin is superior to that of clindamycin alone in prevention of wound infection. A related editorial comment notes that use of this regimen would allow primary closure of the wound at the time of surgery and thus reduce costs by shortening hospital stay and providing quicker wound healing. The study results appear to support the use of this regimen for perforated and gangrenous appendicitis, not all cases of appendicitis. It is also pointed out that some surgeons would not choose clindamycin as the systemic antibiotic to use in these cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibiotics, Drug therapy, Dosage and administration, Appendicitis

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