title: Current Practice in the Management of Open Fractures Among Orthopaedic Trauma Surgeons. Part A: Initial Management. A Survey of Orthopaedic Trauma Surgeons.
abstract: OBJECTIVE
  Open fractures are one of the injuries with the highest rate of infection that orthopaedic trauma surgeons treat. The main purpose of this survey was to determine current practice and practice variation among Orthopaedic Trauma Association (OTA) members and make treatment recommendations based on previously published resources.
  
  
  METHODS
  Survey.
  
  
  METHODS
  Web-based survey.
  
  
  METHODS
  Three hundred seventy-nine orthopaedic trauma surgeons.
  
  
  METHODS
  A 15-item questionnaire-based study titled "OTA Open Fracture Survey" was constructed. The survey was delivered to all OTA membership categories. Different components of the data charts were used to analyze numerous aspects of open fracture management, focusing on parameters of initial and definitive treatment.
  
  
  RESULTS
  Eighty-six percent of participants responded that a period of time of less than 1 hour is the optimal time to antibiotic administration after identification of open fracture. Despite concerns with nephrotoxicity, 24.0%-76.3% of respondents reported the use of aminoglycosides in management of open fractures. A little over half of survey respondents continue antibiotics until next debridement in wounds that were not definitively closed after initial debridement and stabilization.
  
  
  CONCLUSIONS
  Rapid administration of antibiotics in open fracture management is important. Aminoglycoside use is still prevalent despite evidence questioning efficacy and toxicity concerns. Time to debridement of open fractures is controversial among OTA members. Antibiotic administration is commonly continued >48 hours despite concerns raised by Surgical Infection Society and The Eastern Association of the Surgery of Trauma. Regarding study logistics, survey participation reminders should be used when conducting this type of study as it can increase data accrual by 50%.
  
  
  METHODS
  Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Orthopaedic Trauma Institute, Vanderbilt University Medical Center, Nashville, TN; †Department of Orthopaedic Surgery, John Peter Smith, Fort Worth, TX; ‡Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA; §Orthopaedic Trauma Service, Florida Orthopaedic Institute and Department of Orthopaedic Surgery, University of South Florida, Tampa, FL; ‖Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN; ¶Department of Orthopaedic Surgery, Scott & White Healthcare, Temple, TX; **Orthopaedic Trauma and Fracture Service, Hospital of the University of Pennsylvania, Philadelphia, PA; and ††Department of Orthopaedics, University of Connecticut Health Center, Farmington, CT.
authors.forename: William
authors.initials: W
authors.lastname: Obremskey
authors.forename: Cesar
authors.initials: C
authors.lastname: Molina
authors.forename: Cory
authors.initials: C
authors.lastname: Collinge
authors.forename: Arvind
authors.initials: A
authors.lastname: Nana
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Claude
authors.initials: C
authors.lastname: Sagi
authors.forename: Andrew
authors.initials: A
authors.lastname: Schmidt
authors.forename: Robert
authors.initials: R
authors.lastname: Probe
authors.forename: Jaimo
authors.initials: J
authors.lastname: Ahn
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Browner
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001458:Bandages; D003646:Debridement; D005597:Fractures, Open / Q000601:surgery*; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D009985:Orthopedics; D010818:Practice Patterns, Physicians'; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents