Article
Application of current concepts in handling exposed fracture of the hand – experience and local results
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Authors
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Patricio Perez
- Universidad de la Frontera, Hospital Regional de Temuco, Temuco, Chile
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Fractures of the hands' fingers constitute the 1.5% of the urgent consultations, 5% of them correspond to exposed fractures, of predominance in masculine sex (70 - 90%), they present variable severity in function of multiple associated factors. In accordance to literature, there is enough evidence to demonstrate that the infection rate in these lesions is low, being the main factor, the early administration of antibiotics, showing no correlation between debridement time and infection rate.
The objective of this paper is to present the results obtained from the management of exposed hand fractures, performed by general doctors at a local hospital in the Araucanía region, Chile, during the year 2018, applying the classification of Tulipan and Iiiyas
Methods: Thirty patients with exposed hand fractures admitted in 2018 were evaluated in the period from January to August of this year; 26 men and 4 women, within an average age of 43 years. All patients received antibiotic prophylaxis with cefazolin + tetanus vaccine, 10 of them classified as I / Ia were handled by general practitioners in a definitive way, patients with more complex lesions were referred to a more complex hospital for evaluation and management by a specialist, of which 6 required pavilion and 4 of them osteosynthesis
Results and Conclusions: During patients' evolution, only 1 of them presented signs of local infection, being managed promptly with ambulatory oral antibiotic scheme, presenting good response and without any surgical intervention needed. From the patients managed in emergency box and in ward, all were kept in serial clinical control, evolving favorably, without signs of infection of the operated site or other associated complications.
From the above, it can be concluded that exposed fractures classified as I-III without modifier, do not require emergency surgical treatment, and can be managed on an outpatient basis, with administration of antibiotic prophylaxis on time, associated with adequate debridement in emergency box.
The application of the new classification of Tulipan has shown promising and consistent results, since a large number of patients could be managed efficiently by general doctors with an adequate prior training, with good and excellent results, achieving the decrease in the need for pavilion and management by specialists, and hence optimize resources.
