title: Treatment of open fractures of the hand in the emergency department.
abstract: Current guidelines suggest early surgical treatment of open fractures. This rule in open hand fractures is not well supported and may be unpractical. Furthermore, desirable debridement and washout can be obtained in the emergency department (ED). The purpose of this study was to evaluate the relationship between the level of contamination, quality of washout in the emergency room, and the development of infection. Sixty-one patients with open fractures of the hand were retrospectively reviewed for demographic and fracture characteristics, and other complications. The infection rate was 14.8%. Contamination was present in 43 patients (70.5%). One thousand milliliters or more were used to obtain a grossly clean wound in 43 patients (70.5%). No significant relationship was found between fracture type, finger involved, hand dominance, comorbidities, and development of infection. The amount of fluid used for washout was significantly related to infection (P = 0.047), whereas wound contamination was not (P = 0.259). Type of oral antibiotic was significantly related to infection (P = 0.039). The level of contamination was not a significant factor in predicting infection, whereas the amount of fluid used for washout and the oral antibiotic type were significant factors in preventing infection. Since administration of intravenous antibiotics and thorough wound cleansing can be performed on open hand fractures in the ED under adequate anesthesia, most open fractures in the hand do not need to be treated early in the operating theater.
authors.affiliation: Department of Orthopedic Surgery, Division of Hand and Upper Extremity Surgery, Technion Israel Institute of Technology School of Medicine, Haifa, Israel.
authors.forename: Nofar Ben
authors.initials: NB
authors.lastname: Basat
authors.affiliation: Department of Orthopedic Surgery, Division of Hand and Upper Extremity Surgery, Technion Israel Institute of Technology School of Medicine, Haifa, Israel.
authors.forename: Raviv
authors.initials: R
authors.lastname: Allon
authors.affiliation: Department of Orthopedic Surgery, Division of Hand and Upper Extremity Surgery, Technion Israel Institute of Technology School of Medicine, Haifa, Israel.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nagmi
authors.affiliation: Department of Orthopedic Surgery, Division of Hand and Upper Extremity Surgery, Technion Israel Institute of Technology School of Medicine, Haifa, Israel. ronitwollstein@gmail.com.|Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. ronitwollstein@gmail.com.
authors.forename: Ronit
authors.initials: R
authors.lastname: Wollstein
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D003646:Debridement / Q000592:standards; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000592:standards; D005260:Female; D005597:Fractures, Open / Q000150:complications / Q000382:microbiology* / Q000628:therapy*; D050276:Hand Bones / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000382:microbiology / Q000517:prevention & control; D007507:Therapeutic Irrigation / Q000592:standards; D014946:Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Debridement; Emergency department; Infection; Lavage; Open fracture