Oflazoglu K, Hoogendoorn J M, van der Zwaal P, Walbeehm E T, van Enst W A, Holtslag H R, Hofstee D, Plantinga P, Elzinga M, Rakhorst H
Research fellow Orthopedic Hand Service, Orthopedic Surgery, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Trauma Surgery, Haaglanden Medical Center, The Hague, The Netherlands.
Eur J Trauma Emerg Surg. 2019 Feb;45(1):99-106. doi: 10.1007/s00068-017-0874-7. Epub 2017 Nov 27.
The British Orthopedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) updated the evidence-based guidelines for the treatment and care of open lower limb fractures (BOAST 4). Following this, a Dutch version has been developed. The main points are multidisciplinary care, planning, and treatment of these injuries. Early osteosynthesis (within 7-14 days) combined with soft-tissue coverage results in more efficient care and less complications.
To study the variation in treatment and thoughts among trauma, orthopedic, and plastic surgeons.
In this cross-sectional study 94 surgeons (57 trauma, 23 plastic, and 14 orthopedic surgeons) working at 46 centers completed an online questionnaire, consisting of 5 demographic, 14 hospital-related, 8 BOAST 4-related, and 2 centralization-related questions.
There was a strong agreement among surgeons about the best moment for multidisciplinary consultation, which was before initial debridement, while in practice, this often does not occur. All surgeons agreed that the initial debridement should be performed immediately by any surgeon, but not solely by trainees. Plastic surgeons responded that the definitive stabilization and wound cover should not exceed 7 days, while half of the trauma and orthopedic surgeons agreed that it should not exceed 14 days. Finally, most surgeons agreed that Gustilo 3 fractures should be centralized. However, there was disagreement on the need for centralization of Gustilo 2 fractures.
Surgeons agree on better and earlier multidisciplinary treatment of open lower limb fractures and the centralization of Gustilo 3 fractures.
英国骨科协会（BOA）和英国整形、重建与美容外科协会（BAPRAS）更新了开放性下肢骨折治疗与护理的循证指南（BOAST 4）。在此之后，又制定了荷兰语版本。要点包括这些损伤的多学科护理、规划和治疗。早期骨固定（7 - 14天内）联合软组织覆盖可实现更有效的护理并减少并发症。
研究创伤外科医生、骨科医生和整形外科医生在治疗方法及观点上的差异。
在这项横断面研究中，46个中心的94名外科医生（57名创伤外科医生、23名整形外科医生和14名骨科医生）完成了一份在线问卷，问卷包含5个人口统计学问题、14个与医院相关的问题、8个与BOAST 4相关的问题以及2个与集中治疗相关的问题。
外科医生们对于多学科会诊的最佳时机（在初次清创前）意见高度一致，但在实际操作中，这种情况常常并未发生。所有外科医生都认为初次清创应由任何外科医生立即进行，但不应仅由实习医生操作。整形外科医生回应称确定性固定和伤口覆盖不应超过7天，而一半的创伤外科医生和骨科医生则认为不应超过14天。最后，大多数外科医生同意Gustilo 3型骨折应进行集中治疗。然而，对于Gustilo 2型骨折是否需要集中治疗存在分歧。
外科医生们对于开放性下肢骨折更好、更早地进行多学科治疗以及Gustilo 3型骨折的集中治疗达成了共识。
