Actualización en el Manejo de las Fracturas Abiertas

RESUMO

1. Initial gram stains at the emergency room are mandatory 2. Careful and sistematic irrigation and debridement have to be performed in every case. 3.Type II and III open fractures must be taken back to the O.R. 24-48 hours later and revised personally by the attending Phisician. 4. No primary closure should be performed of type II and III open fractures. We recomend delay primary closure by means of direct suture or diferents plastic procedures. 5. A succesful end result will mainly depend of the quality of the initial management. The prophilactic antibiotics are useful in the treatment of open fractures. They should be used for a short period op time ( 24-72 hrs). No mixture of antibiotics will substitute meticulous decontamination and debridement of the wound. Established infection must be treated following the basic principles of antibiotics therapy. The use and indications of common local antiseptics have to be resised. Early operative stabilization by means of internal or external fixation plays a definitive role in the management of open fractures and associated lesions. The traditional approach of treat the wounds firs and then the fracture has changed, specially for type II and III injures. The agressive trauma treatment in politrauma patients with multiple lesions has many advantages for the post-operative care and rapid recovery, but this type of treatment should only be performed by well-trained surgeons with experience in the techniques of stable osteosynthesis. Finally, unilateral external fixation with the improvements in the materials and the mode of applications has add a new dimension for the patients and their lesions as it is a simple methos, versatile and allows early weght-bearing