A Randomized Controlled Study to Compare Conventional and Evidence Based Treatment Protocols in Fresh Compound Fractures.

INTRODUCTION A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George's Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP). AIM To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union. MATERIALS AND METHODS This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review. STATISTICAL ANALYSIS Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint. RESULTS Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343). CONCLUSION EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture healing. Therefore EBP is recommended for use in settings like the KGMU trauma center.

[1]  R. Ahmad,et al.  Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh India- 226003 , 2016 .

[2]  G. Kumar,et al.  Prevention of Infection in the Treatment of One Thousand and Twenty-Five Open Fractures of Long Bones. Retrospective and Prospective Analyses , 2014 .

[3]  D. Anderson.  Prevention of surgical-site infections. , 2010, The New England journal of medicine.

[4]  J. Beam.  Occlusive dressings and the healing of standardized abrasions. , 2008, Journal of athletic training.

[5]  M. Lubbers,et al.  Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial. , 2008, Archives of surgery.

[6]  A. D'Souza,et al.  The Use of Qualitative Cultures for Detecting Infection in Open Tibial Fractures , 2008, Journal of orthopaedic surgery.

[7]  Avi Pfeffer,et al.  INFLUENCE OF , 2014 .

[8]  J. Tanner,et al.  Preoperative hair removal to reduce surgical site infection. , 2006, The Cochrane database of systematic reviews.

[9]  M. Pagnano,et al.  Prevention of Wound Contamination Using DuraPrep™ Solution Plus Ioban™ 2 Drapes , 2005, Clinical orthopaedics and related research.

[10]  J. Anglen.  Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. , 2005, The Journal of bone and joint surgery. American volume.

[11]  M. Parker,et al.  Closed suction drainage for hip and knee arthroplasty. A meta-analysis. , 2004, The Journal of bone and joint surgery. American volume.

[12]  G. Christensen,et al.  The use of detergent irrigation for musculoskeletal wounds , 2002, International Orthopaedics.

[13]  G. Christensen,et al.  Comparison of castile soap, benzalkonium chloride, and bacitracin as irrigation solutions for complex contaminated orthopaedic wounds. , 1999, Journal of orthopaedic trauma.

[14]  G. Christensen,et al.  Benzalkonium Chloride: A Potential Disinfecting Irrigation Solution for Orthopaedic Wounds , 1998 .

[15]  S. Benrimoj,et al.  Topical Antimicrobial Prophylaxis in Minor Wounds , 1997, The Annals of pharmacotherapy.

[16]  D. Seligson,et al.  Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases. , 1995, The Journal of bone and joint surgery. British volume.

[17]  C. Baxter,et al.  Immunologic reactions in chronic wounds. , 1994, American journal of surgery.

[18]  K M Sedlarik,et al.  [Wound dressings]. , 1994, Medizinische Monatsschrift fur Pharmazeuten.

[19]  T. Slama,et al.  Prophylaxis against infection in total joint arthroplasty. One day of cefuroxime compared with three days of cefazolin. , 1994, The Journal of bone and joint surgery. American volume.

[20]  D L Morris,et al.  Laser Doppler Flowmetry in Evaluation of Cutaneous Wound Blood Flow Using Various Suturing Techniques , 1992, Annals of surgery.

[21]  C. L. Johnson,et al.  Occlusive dressings: therapeutic agents and effects on drug delivery. , 1991, Clinics in dermatology.

[22]  J. Lawrence,et al.  Wound infection under occlusive dressings. , 1991, The Journal of hospital infection.

[23]  S. J. Saydak.  A pilot test of two methods for the treatment of pressure ulcers. , 1990, Journal of enterostomal therapy.

[24]  M. Ritter,et al.  Retrospective evaluation of an iodophor-incorporated antimicrobial plastic adhesive wound drape. , 1988, Clinical orthopaedics and related research.

[25]  D. Kernodle,et al.  Influence of preoperative showers on staphylococcal skin colonization: a comparative trial of antiseptic skin cleansers. , 1988, The Annals of thoracic surgery.

[26]  B. Moir-Bussy.  The surgical wound. , 1986, Nursing.

[27]  T. Moore,et al.  Considerations in reducing the infection rate in open tibial fractures. , 1983, Clinical orthopaedics and related research.

[28]  J. Alexander,et al.  The influence of hair-removal methods on wound infections. , 1983, Archives of surgery.

[29]  G. Winter,et al.  Formation of the Scab and the Rate of Epithelization of Superficial Wounds in the Skin of the Young Domestic Pig , 1962, Nature.

[30]  T. Hume.  Dressings , 1880, The Indian medical gazette.