title: Is operative management of fractures safe in the collocated burn and fracture injury?
abstract: OBJECTIVE
  To review the management of a collocated major fracture and dermal burn injury in adult multi-trauma patients. In particular, this study examines the methods and timing for fracture fixation and the fracture complications observed.
  
  
  METHODS
  A retrospective chart review of all patients admitted to the Alfred Hospital, Melbourne, Australia from January 2000 to December 2012 with a collocated dermal burn and major fracture.
  
  
  RESULTS
  Of the 22 patients included (median abbreviated injury score-98 of 22 and total burn surface area of 8%), 17 underwent operative fracture fixation. Eleven patients had internal fixation, two had external fixation and four had temporary external fixation with delayed internal fixation. Median time to operative fixation was 5.7h (interquartile range: 3.5-16.8), with 15 of the 17 patients undergoing fixation within 24h. Nine patients experienced a fracture complication. Five patients had an infective fracture complication (wound infection or osteomyelitis), and all of these patients had had internal fixation. No fracture complications occurred in patients managed conservatively.
  
  
  CONCLUSIONS
  Previous studies have supported the use of internal fixation for early mobility and simplified wound care. However, we observed a high rate of fracture complications with internal fixation, despite undergoing management within 24h of presentation. At this point, we are unable to conclude on the safety of utilising internal fixation in the collocated injury.
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: drlukebradshaw@gmail.com.
authors.forename: Luke
authors.initials: L
authors.lastname: Bradshaw
authors.affiliation: Victorian Adult Burns Service and School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia; Department of Surgery, Central and Eastern Clinical School, Monash University, Melbourne, Victoria, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Cleland
mesh_terms: D000328:Adult; D002056:Burns / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005597:Fractures, Open / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D061646:Operative Time; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery*; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014946:Wound Infection / Q000209:etiology / Q000601:surgery*
keywords: Burn; Fracture; Infection; Internal fixation; Multi-trauma