Traumatic Arthrotomies: Do They All Need the Operating Room?

Szczegóły
Abstrakt

Tytuł:: Traumatic Arthrotomies: Do They All Need the Operating Room?
Autorzy:: McKnight RR; Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC.
Ruffolo M; Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC.
Wally MK; Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC.
Seymour RB; Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC.
Jeray K; Department of Orthopaedic Surgery, Prisma Health-Upstate, Greenville, SC.
E Matuszewski P; Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, KY; and.
Weinlein J; Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Regional One Health, Memphis, TN.
Hsu JR; Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC.
Corporate Authors:: Southeast Fracture Consortium
Źródło:: Journal of orthopaedic trauma [J Orthop Trauma] 2021 Nov 01; Vol. 35 (11), pp. 612-618.
Typ publikacji:: Journal Article; Multicenter Study; Observational Study
Język:: English
Imprint Name(s):: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: [New York, N.Y.] : Raven Press, [c1987-
MeSH Terms:: Fractures, Bone*
Operating Rooms*
Humans ; Retrospective Studies ; Trauma Centers ; Treatment Outcome
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Molecular Sequence:: ClinicalTrials.gov NCT02841644
Entry Date(s):: Date Created: 20210813 Date Completed: 20211025 Latest Revision: 20230828
Update Code:: 20240105
DOI:: 10.1097/BOT.0000000000002093
PMID:: 34387570
: Czasopismo naukowe

Objectives: To compare complications and cost of care in patients with traumatic arthrotomies (TAs) treated with surgical debridement, irrigation, and closure to those treated with nonoperative treatment and local wound care.
Design: This is a prospective observational multicenter study.
Setting: This study was conducted at multiple Level I trauma centers.
Patients: Patients with TAs.
Intervention: Patients were treated with operative versus nonoperative management decided by the attending surgeon. Nonoperative treatment of TAs included bedside irrigation, primary closure, antibiotics, and discharge from the emergency department with close follow-up unless admission was otherwise indicated.
Main Outcome Measurements: Primary outcomes included adverse outcomes and cost. VR-12 was captured at the time of injury and 3 months postinjury.
Results: Of 189 major joint TAs, 64 arthrotomies were treated nonoperatively and 125 operatively. Seventy percent of the arthrotomies in the nonoperative group were small (less than 50 mm in size) and 95% had minimal/no gross contamination, whereas the operative group (OG) had significantly more arthrotomies greater than 50 mm in size and with moderate/severe gross contamination. There was one septic joint in the nonoperative group (1.5%) and 7 in the OG (5.6%). Nonoperative treatment was associated with significantly lower total charges when compared with the OG.
Conclusions: Although further study may still be needed, this study suggests that small, minimally contaminated TAs with no associated fracture have a low risk of adverse complications, can safely be treated nonoperatively, and are associated with a significantly decreased cost of care.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: J. D. Adams reports payment for consultant with Arthrex, Inc, payment as a speaker for AONA, and is an AAOS board or committee member. M. Bosse reports Orthopaedic Implant Company stock ownership. J. R. Hsu reports personal fees from Smith & Nephew and Globus Medical. K. Jeray reports paid consulting for Radius and Zimmer. S. Odum reports personal fees from the American Academy of Orthopaedic Surgeons. T. Schaller reports a grant from Smith Nephew and honorarium for lecture with Smith Nephew. R. B. Seymour reports a grant from the Southeast Fracture Consortium. M. K. Wally reports a grant from the Centers for Disease Control and Prevention. J. Weinlein reports royalties from Elsevier. The remaining authors report no conflict of interest.
(Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

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