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Orthoplastic Care Improves Open Fracture Outcomes: A Systematic Review
Eddy Rios, B.S.; Mikhail Kuznetsov B.S.; Anam J Furrukh, B.A; Anneka Ignatius, B.A; Giorgio Giatsidis MD/PhD
RESICE Lab. Department of Surgery - Plastic and Reconstructive Division, UMASS Chan Medical School, Worcester, MA
Background: In 2019, there were 178 million global fractures. Open fractures have poor outcomes, with infection rates as high as 63%. In cohort studies, open fracture collaborative management by orthopedic and plastic surgeons - “orthoplastic” care (OPC) - seems to variably affect infection rates (-27% - +92% reduction) and time to skeletal stabilization (-95% - +53% reduction). Given conflicting outcomes and lack of powerful analyses, we reviewed orthoplastic literature. We hypothesized that OPC improves risks of post-operative infection, secondary amputation, and flap failure. We also hypothesized that OPC reduces hospital stay(days), time to surgical skeletal stabilization/soft tissue coverage(hours), and time to bone union(days).
Methods: A PRISMA-compliant search was conducted on PubMeD, Cochrane, and Google Scholar; 4067 publications were screened. Inclusion criteria were studies in which OPC of open fractures was compared with non-OPC. Significance was determined using Fischer’s exact test for categorical data and two-sample t-testing for continuous data.
Results: 15 studies (UK n=9; US n= 2; other n=4) encompassing 17,880 patients were included. OPC improved risks of secondary infection (10% vs 23%, p=0.0001), amputation (1.9% vs 4.1%, p=0.023), and flap failure (7.5% vs 22%, p=0.043). OPC reduced length of hospital stay (22 vs 39 days; p< 0.0001) and reduced time to skeletal stabilization (19 vs 32 hours; p< 0.0001), soft tissue coverage (72 vs 129 hours; p< 0.0001), and radiologic bone union (203 vs 274 days; p< 0.0001).
Conclusion: Despite variation in cohort study results, OPC seems to significantly benefit patients suffering open fractures by improving several pertinent outcomes.
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