title: Current management of open fractures: results from an online survey.
abstract: BACKGROUND
  Open fractures are orthopaedic emergencies that carry a high risk for infection, non-union and soft tissue complications. Evidence-based treatment is impeded by the lack of high-quality evidence-based studies. The aim of this investigation was to elucidate the current practice of open fracture management in Germany and to determine major differences in treatment.
  
  
  METHODS
  Surgeons were asked to complete an online questionnaire consisting of 45 items developed by an expert consensus. The first part covered questions on general principles of open fracture management. The second part included questions on soft tissue management, the preferred method of initial surgical stabilisation, microbiological testing, employment of pulsatile lavage and local antibiotics, antibiotic regimen, second-look operations, and blood testing.
  
  
  RESULTS
  Of 653 respondents, 364 (65 %) completed the first part and 314 (48 %) completed the second part of the online survey. 55 % answered that a standard operating procedure for the diagnosis and treatment of patients with open fractures exists in their hospital. Only 25 % leave pre-hospitalisation applied dressings intact until arrival of the patient in the operating room, and 40 % make this decision depending on information provided by pre-hospitalisation emergency personnel. 84 % participants exclude the use of antibiotic-coated implants in the treatment of open fractures. The favoured stabilisation method in Gustilo type I fractures is definitive internal osteosynthesis and primary wound closure for 61 % of respondents. In Gustilo type II (74 %) and type III fractures (93 %), temporary external fixation is preferred. High-pressure pulsatile lavage is used by 22 % responding surgeons in Gustilo type I fractures, 53 % for type II fractures and 67 % for type III fractures.
  
  
  CONCLUSIONS
  Open fracture management differs considerably among surgeons in Germany. Further studies are needed to deliver high-quality evidence concerning primary fracture stabilisation, soft tissue management and second-look operations. Existing evidence-based recommendations for general treatment, antibiotic prophylaxis and soft tissue management should be followed more strictly in clinical practice.
authors.affiliation: Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Germany. denis.guembel@uni-greifswald.de.|Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany. denis.guembel@uni-greifswald.de.
authors.forename: Denis
authors.initials: D
authors.lastname: Gümbel
authors.affiliation: Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Germany.|Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Matthes
authors.affiliation: Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Napp
authors.affiliation: Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Lange
authors.affiliation: Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hinz
authors.affiliation: Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.
authors.forename: Romy
authors.initials: R
authors.lastname: Spitzmüller
authors.affiliation: Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Germany.|Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Ekkernkamp
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001458:Bandages; D002985:Clinical Protocols; D005593:Fracture Fixation, Internal / Q000379:methods*; D005597:Fractures, Open / Q000601:surgery*; D005858:Germany / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D015994:Incidence; D011795:Surveys and Questionnaires; D014946:Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Compound; Fracture; Infection prophylaxis; Management; Open; Soft tissue; Trauma