title: A Randomized Controlled Study to Compare Conventional and Evidence Based Treatment Protocols in Fresh Compound Fractures.
abstract: BACKGROUND
  A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George's Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP).
  
  
  OBJECTIVE
  To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union.
  
  
  METHODS
  This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review.
  
  
  METHODS
  Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint.
  
  
  RESULTS
  Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343).
  
  
  CONCLUSIONS
  EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture healing. Therefore EBP is recommended for use in settings like the KGMU trauma center.
authors: PhD, Department of Orthopedic Surgery, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors: Kanika
authors: K
authors: Mahajan
authors: Associate Professor, Department of Orthopedic Surgery, Era's Lucknow Medical College and Hospital , Lucknow, Uttar Pradesh, India .
authors: Vikas
authors: V
authors: Verma
authors: Director, All India Institute of Medical Sciences-Patna , Patna, Bihar, India .
authors: Girish Kumar
authors: GK
authors: Singh
authors: Professor, Department of Orthopedic Surgery, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors: Santosh
authors: S
authors: Kumar
authors: Associate Professor, Department of Emergency Medicine, Ram Manohar Lohia Institute of Medical Sciences , Lucknow, Uttar Pradesh, India .
authors: Sachin
authors: S
authors: Avasthi
keywords: Culture; Fracture; Infection; Occlusive dressing; Povidone iodine; Wound