Capo John T, Hall Michael, Nourbakhsh Ali, Tan Virak, Henry Patrick
University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
Am J Orthop (Belle Mead NJ). 2011 Dec;40(12):E243-8.
We retrospectively reviewed the cases of patients with open hand fractures and/or dislocations managed at our institution between 2001 and 2009. The management protocol consisted of irrigation and debridement, reduction (if necessary), splinting, and antibiotics administration in the emergency department. Patients with vascular compromise or severe mangling open wounds were taken to the operating room for treatment. Data regarding demographics, wound size and modified Gustilo-Anderson classification, and timing of interventions were recorded. Included in the study were 145 cases (91 class III, 41 class II, and 13 class I injuries). In 102 cases, definitive and final management took place in the emergency department; in the other 43 cases, additional management took place in the operating room. Antibiotics were administered within 4 hours after injury, and irrigation and debridement were performed within 6 hours. Each of the 2 infections (1.4%) developed in a class III injury. In open hand fractures, particularly type I and type II wounds, the protocol we followed can be appropriate when the injury is not the severe mangling type and does not require acute vascular repair.
我们回顾性分析了2001年至2009年间在我院接受治疗的开放性手部骨折和/或脱位患者的病例。治疗方案包括在急诊科进行冲洗和清创、复位（如有必要）、夹板固定及给予抗生素。有血管损伤或严重毁损开放性伤口的患者被送往手术室治疗。记录了患者的人口统计学资料、伤口大小及改良的 Gustilo-Anderson 分类以及干预时机。本研究纳入145例病例（Ⅲ级91例、Ⅱ级41例、Ⅰ级13例）。102例患者在急诊科进行了确定性和最终治疗；另外43例患者在手术室进行了进一步治疗。受伤后4小时内给予抗生素，6小时内进行冲洗和清创。2例感染（1.4%）均发生在Ⅲ级损伤患者中。在开放性手部骨折中，尤其是Ⅰ型和Ⅱ型伤口，当损伤不是严重毁损类型且不需要急性血管修复时，我们遵循的方案可能是合适的。
