Kanika Mahajan1, Vikas Verma2, Girish Kumar Singh3, Santosh Kumar4, Sachin Avasthi5. 1. PhD, Department of Orthopedic Surgery, King George's Medical University , Lucknow, Uttar Pradesh, India . 2. Associate Professor, Department of Orthopedic Surgery, Era's Lucknow Medical College and Hospital , Lucknow, Uttar Pradesh, India . 3. Director, All India Institute of Medical Sciences-Patna , Patna, Bihar, India . 4. Professor, Department of Orthopedic Surgery, King George's Medical University , Lucknow, Uttar Pradesh, India . 5. Associate Professor, Department of Emergency Medicine, Ram Manohar Lohia Institute of Medical Sciences , Lucknow, Uttar Pradesh, India .
Abstract
INTRODUCTION: A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George's Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP). AIM: To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union. MATERIALS AND METHODS: This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review. STATISTICAL ANALYSIS: Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint. RESULTS: Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343). CONCLUSION:EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture healing. Therefore EBP is recommended for use in settings like the KGMU trauma center.
RCT Entities:
INTRODUCTION: A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George's Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP). AIM: To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union. MATERIALS AND METHODS: This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review. STATISTICAL ANALYSIS: Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint. RESULTS: Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343). CONCLUSION:EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture healing. Therefore EBP is recommended for use in settings like the KGMU trauma center.
Authors: Cassie Jacobson; Douglas R Osmon; Arlen Hanssen; Robert T Trousdale; Mark W Pagnano; Janine Pyrek; Elie Berbari; James Naessens Journal: Clin Orthop Relat Res Date: 2005-10 Impact factor: 4.176
Authors: Nicholas Fletcher; D'Mitri Sofianos; Marschall Brantling Berkes; William T Obremskey Journal: J Bone Joint Surg Am Date: 2007-07 Impact factor: 5.284
Authors: D R Mauerhan; C L Nelson; D L Smith; R H Fitzgerald; T G Slama; R W Petty; R E Jones; R P Evans Journal: J Bone Joint Surg Am Date: 1994-01 Impact factor: 5.284
Authors: B P Conroy; J O Anglen; W A Simpson; G Christensen; G Phaup; R Yeager; B J Gainor Journal: J Orthop Trauma Date: 1999 Jun-Jul Impact factor: 2.512
Authors: James K-K Chan; Alexander L Aquilina; Sharon R Lewis; Jeremy N Rodrigues; Xavier L Griffin; Jagdeep Nanchahal Journal: Cochrane Database Syst Rev Date: 2022-04-01