tailieunhanh - Chấn thương cơ xương

Tham khảo tài liệu 'chấn thương cơ xương', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | Perspectives on Modern Orthopaedics Wound Irrigation in Musculoskeletal Injury Jeffrey O. Anglen MD Abstract Wound irrigation to remove debris and lessen bacterial contamination is an essential component of open fracture care. However considerable practice variation exists in the details of technique. Volume is an important factor increased volume improves wound cleansing to a point but the optimal volume is unknown. High-pressure flow has been shown to remove more bacteria and debris and to lower the rate of wound infection compared with low-pressure irrigation although recent in vitro and animal studies suggest that it may also damage bone. Pulsatile flow has not been demonstrated to increase efficacy. Antiseptic additives can kill bacteria in the wound but host-tissue toxicities limit their use. Animal and clinical studies of the use of antiseptics in contaminated wounds have yielded conflicting outcomes. Antibiotic irrigation has been effective in experimental studies in some types of animal wounds but human clinical data are unconvincing due to poor study design. There are few animal or clinical studies of musculoskeletal wounds. Detergent irrigation aims to remove rather than kill bacteria and has shown promise in animal models of the complex contaminated musculoskeletal wound. J Am Acad Orthop Surg 2001 9 219-226 According to hospital discharge data there are approximately 6 million fractures in the United States annually and million open On the basis of statistics from European studies it has been estimated that 4 of fractures are open suggesting that there are nearly 250 000 open fractures annually in this Compared with closed fractures open fractures have a higher incidence of infection nonunion and other adverse outcomes that lead to increased cost of treatment and result in less satisfactory recovery for the patient. Many of the factors that increase the risk of infection in open fractures are beyond the control of the surgeon .