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Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review / Kouamé Jean-Eric Kouassi in Acta Orthopaedica Belgica, Vol.87/1 (Mars 2021)
[article]
Titre : Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review Type de document : texte imprimé Auteurs : Kouamé Jean-Eric Kouassi ; Julie Manon ; Loïc Fonkoue ; Christine Detrembler ; Olivier Cornu Année de publication : 2021 Article en page(s) : p. 85-92 Note générale : https://doi.org/10.52628/87.1.11 Langues : Anglais (eng) Mots-clés : Africa cast immobilization developing countries open fracture tibia Résumé : Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting.
A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS).
Eight papers met the inclusion criteria and had an average CMS of 70 (range 54-73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation.
Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost.Permalink : ./index.php?lvl=notice_display&id=96590
in Acta Orthopaedica Belgica > Vol.87/1 (Mars 2021) . - p. 85-92[article] Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review [texte imprimé] / Kouamé Jean-Eric Kouassi ; Julie Manon ; Loïc Fonkoue ; Christine Detrembler ; Olivier Cornu . - 2021 . - p. 85-92.
https://doi.org/10.52628/87.1.11
Langues : Anglais (eng)
in Acta Orthopaedica Belgica > Vol.87/1 (Mars 2021) . - p. 85-92
Mots-clés : Africa cast immobilization developing countries open fracture tibia Résumé : Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting.
A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS).
Eight papers met the inclusion criteria and had an average CMS of 70 (range 54-73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation.
Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost.Permalink : ./index.php?lvl=notice_display&id=96590 Exemplaires (1)
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Exclu du prêtA Descriptive Study On The Surgery And The Microbiology Of Gustilo Type III Fractures In An University Hospital In Switzerland / Erlangga YUSUF in Acta Orthopaedica Belgica, Vol 81/2 (Juin 2015)
[article]
Titre : A Descriptive Study On The Surgery And The Microbiology Of Gustilo Type III Fractures In An University Hospital In Switzerland Type de document : texte imprimé Auteurs : Erlangga YUSUF, Auteur ; Julia STEINRÜCKEN, Auteur ; Thomas BUCHEGGER, Auteur Année de publication : 2015 Article en page(s) : p.327-332 Langues : Anglais (eng) Mots-clés : Trauma open fracture infection microbiology antibiotic prophylaxis Résumé : Objective: To describe the epidemiology, the surgical treatment, the microbiology, the antibiotic prophylaxis and the outcome of patients with the most severe type of open fractures.
Methods: Retrospective chart reviews of patients with Gustilo type III open fracture admitted to an university hospital in Switzerland between January 2007 and December 2011. The patient’s and fracture’s characteristics, surgery, antibiotic prophylaxis, and microbiology findings at the initial and at the revision surgery were described. Results: Thirty patients were included (83% male, mean age 41 years). More than half of the patients had polytrauma. In all patients, debridement and stabilization surgery (70% using external fixation) were performed at admission. Soft tissue reconstruction was performed in 87% and in 23% immediate bone graft was performed. Antibiotic prophylaxis were given in all patients for a median duration of 9 days (60% received amoxicillin/clavulanic acid). Positive bacterial culture was found in 53% of the patients at initial surgery and in 88% at revision surgery. At initial and revision surgery, 47% and 88% of the pathogens were amoxicillin/clavulanic acid-resistant. Treatment outcome was favorable in 24 of 30 patients (80%) and in six cases (20%) an amputation had to be performed. None of the patients had chronic bone infection.
Conclusions: Positive cultures were found often in open fractures. Amoxicillin/clavulanic acid which is often mentioned in many guidelines as prophylaxis in open fractures does not cover the most common isolated organisms. The combination of surgery and antibiotic prophylaxis leads to good outcome in Gustilo type III fracture.Permalink : ./index.php?lvl=notice_display&id=40664
in Acta Orthopaedica Belgica > Vol 81/2 (Juin 2015) . - p.327-332[article] A Descriptive Study On The Surgery And The Microbiology Of Gustilo Type III Fractures In An University Hospital In Switzerland [texte imprimé] / Erlangga YUSUF, Auteur ; Julia STEINRÜCKEN, Auteur ; Thomas BUCHEGGER, Auteur . - 2015 . - p.327-332.
Langues : Anglais (eng)
in Acta Orthopaedica Belgica > Vol 81/2 (Juin 2015) . - p.327-332
Mots-clés : Trauma open fracture infection microbiology antibiotic prophylaxis Résumé : Objective: To describe the epidemiology, the surgical treatment, the microbiology, the antibiotic prophylaxis and the outcome of patients with the most severe type of open fractures.
Methods: Retrospective chart reviews of patients with Gustilo type III open fracture admitted to an university hospital in Switzerland between January 2007 and December 2011. The patient’s and fracture’s characteristics, surgery, antibiotic prophylaxis, and microbiology findings at the initial and at the revision surgery were described. Results: Thirty patients were included (83% male, mean age 41 years). More than half of the patients had polytrauma. In all patients, debridement and stabilization surgery (70% using external fixation) were performed at admission. Soft tissue reconstruction was performed in 87% and in 23% immediate bone graft was performed. Antibiotic prophylaxis were given in all patients for a median duration of 9 days (60% received amoxicillin/clavulanic acid). Positive bacterial culture was found in 53% of the patients at initial surgery and in 88% at revision surgery. At initial and revision surgery, 47% and 88% of the pathogens were amoxicillin/clavulanic acid-resistant. Treatment outcome was favorable in 24 of 30 patients (80%) and in six cases (20%) an amputation had to be performed. None of the patients had chronic bone infection.
Conclusions: Positive cultures were found often in open fractures. Amoxicillin/clavulanic acid which is often mentioned in many guidelines as prophylaxis in open fractures does not cover the most common isolated organisms. The combination of surgery and antibiotic prophylaxis leads to good outcome in Gustilo type III fracture.Permalink : ./index.php?lvl=notice_display&id=40664 Exemplaires (1)
Cote Support Localisation Section Disponibilité Revue Revue Centre de Documentation HELHa Campus Montignies Armoires à volets Document exclu du prêt - à consulter sur place
Exclu du prêt