Swanson T V, Szabo R M, Anderson D D
University of California, Davis Medical Center, Department of Orthopaedics, Sacramento 95817.
J Hand Surg Am. 1991 Jan;16(1):101-7. doi: 10.1016/s0363-5023(10)80021-8.
Two hundred open fractures distal to the carpus in one hundred twenty-one patients were studied retrospectively. One hundred seventy-three fractures were followed-up to complete bony union, which occurred at a median period of seven weeks. Ninety-seven total complications included nine wound infections in seven patients, eighteen malunions, seventeen delayed or nonunions, twenty-three fixation problems, and two late amputations. Infection rate increased in the presence of wound contamination, delay in treatment greater than twenty-four hours, or systemic illness. It was not increased by presence of internal fixation, immediate wound closure, large wound size, tendon/nerve/vascular injury, or high-energy mechanism. We suggest a classification predictive of infection: type I: Clean wound and no systemic illness; type II: Contaminated wound, delay in treatment greater than twenty-four hours, or significant systemic illness. We recommend choosing fracture stabilization on the basis of the mechanical needs of the fracture, regardless of wound size, injury energy, or contamination. Immediate wound closure is appropriate for type I injuries and delayed closure should be reserved for type II wounds.
对121例患者的200例腕关节远端开放性骨折进行了回顾性研究。173例骨折随访至骨性愈合完成，中位愈合时间为7周。97例并发症包括7例患者出现9处伤口感染、18处畸形愈合、17处延迟愈合或不愈合、23处固定问题以及2例晚期截肢。伤口污染、治疗延迟超过24小时或存在全身疾病时感染率增加。内固定、伤口一期闭合、伤口面积大、肌腱/神经/血管损伤或高能损伤机制并不会增加感染率。我们提出一种感染预测分类：I型：清洁伤口且无全身疾病；II型：污染伤口、治疗延迟超过24小时或存在严重全身疾病。我们建议根据骨折的力学需求选择骨折固定方式，而不考虑伤口大小、损伤能量或污染情况。I型损伤适合一期伤口闭合，II型伤口应采用延迟闭合。
