Osteomyelitis Risk Factors Related to Combat Trauma Open Upper Extremity Fractures: A Case-Control Analysis.
J Orthop Trauma
; 33(12): e475-e483, 2019 Dec.
Article
em En
| MEDLINE
| ID: mdl-31356447
ABSTRACT
OBJECTIVE:
To determine risk factors for osteomyelitis in US military personnel with combat-related, extremity long bone (humerus, radius, and ulna) open fractures.DESIGN:
Retrospective observational case-control study.SETTING:
US military regional hospital in Germany and tertiary care military hospitals in the United States (2003-2009). PATIENTS/PARTICIPANTS:
Sixty-four patients with open upper extremity fractures who met diagnostic osteomyelitis criteria (medical record review verification) were classified as cases. Ninety-six patients with open upper extremity fractures who did not meet osteomyelitis diagnostic criteria were included as controls. INTERVENTION Not applicable. MAIN OUTCOME MEASUREMENTS Multivariable odds ratios (ORs; 95% confidence interval [CI]).RESULTS:
Among patients with surgical implants, osteomyelitis cases had longer time to definitive orthopaedic surgery compared with controls (median 26 vs. 11 days; P < 0.001); however, there was no significant difference with timing of radiographic union. Being injured between 2003 and 2006, use of antibiotic beads, Gustilo-Anderson [GA] fracture classification (highest with GA-IIIb [OR 22.20; CI 3.60-136.95]), and Orthopaedic Trauma Association Open Fracture Classification skin variable (highest with extensive degloving [OR 15.61; CI 3.25-74.86]) were independently associated with osteomyelitis risk. Initial stabilization occurring outside of the combat zone was associated with reduced risk of osteomyelitis.CONCLUSIONS:
Open upper extremity fractures with severe soft-tissue damage have the highest risk of developing osteomyelitis. The associations with injuries sustained 2003-2006 and location of initial stabilization are likely from evolving trauma system recommendations and practice patterns during the timeframe. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Base de dados:
MEDLINE
Assunto principal:
Osteomielite
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Extremidade Superior
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Ossos do Braço
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Fraturas Expostas
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Militares
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article