Abstract：
BACKGROUND: Open tibia fracture (OTF) causes a considerable increase in morbidity and risk for complications compared to closed fractures. The most significant OTF complication leading to morbidity is commonly considered to be fracture-related infection (FRI). In September 2016, Tampere University Hospital (TAUH) introduced a treatment protocol for OTFs based on the BOAST 4 guideline. The aim of this study is to investigate the outcomes before and after implementation of the OTF treatment protocol.
METHODS: A retrospective cohort study was conducted using handpicked data from the patient record databases of TAUH from May 1, 2007, to May 10, 2021. For patients with OTF, we collected descriptive information, known risk factors for FRI and nonunion, bony fixation method, possible soft tissue reconstruction method, information about the timing of internal fixation and soft tissue coverage, and timing of primary operation. As outcome measures, we collected information on FRI, reoperation due to non-union, flap failure, and secondary amputation. We then compared the incidence of complications before and after the implementation of the OTF treatment protocol at TAUH.
RESULTS: After predefined exclusions, a total of 203 patients with OTF were included. Of these, 141 were treated before and 62 after the implementation of the OTF treatment protocol. The FRI rate in the pre-protocol group was significantly higher compared to the protocol group (20.6% vs 1.6%, p = 0.0015). The incidence of reoperation due to nonunion was also significantly higher in the pre-protocol group (27.7% vs 9.7%, p = 0.0054). According to multivariable analysis, definitive fixation and soft tissue coverage performed in separate operations was an independent risk factor for both FRI and reoperation due to nonunion.
CONCLUSIONS: After implementation, the BOAST 4 based OTF treatment protocol reduced the rate of FRI and reoperation due to nonunion in patients with OTF treated at TAUH during the study period. We, therefore, recommend the implementation of such a treatment protocol in all major trauma centers treating patients with OTF. Furthermore, we also recommend the immediate referral of patients with complex OTF from hospitals lacking the preconditions to provide BOAST 4 based treatment to specialized centers.
METHODS: A retrospective cohort study was conducted using handpicked data from the patient record databases of TAUH from May 1, 2007, to May 10, 2021. For patients with OTF, we collected descriptive information, known risk factors for FRI and nonunion, bony fixation method, possible soft tissue reconstruction method, information about the timing of internal fixation and soft tissue coverage, and timing of primary operation. As outcome measures, we collected information on FRI, reoperation due to non-union, flap failure, and secondary amputation. We then compared the incidence of complications before and after the implementation of the OTF treatment protocol at TAUH.
RESULTS: After predefined exclusions, a total of 203 patients with OTF were included. Of these, 141 were treated before and 62 after the implementation of the OTF treatment protocol. The FRI rate in the pre-protocol group was significantly higher compared to the protocol group (20.6% vs 1.6%, p = 0.0015). The incidence of reoperation due to nonunion was also significantly higher in the pre-protocol group (27.7% vs 9.7%, p = 0.0054). According to multivariable analysis, definitive fixation and soft tissue coverage performed in separate operations was an independent risk factor for both FRI and reoperation due to nonunion.
CONCLUSIONS: After implementation, the BOAST 4 based OTF treatment protocol reduced the rate of FRI and reoperation due to nonunion in patients with OTF treated at TAUH during the study period. We, therefore, recommend the implementation of such a treatment protocol in all major trauma centers treating patients with OTF. Furthermore, we also recommend the immediate referral of patients with complex OTF from hospitals lacking the preconditions to provide BOAST 4 based treatment to specialized centers.
摘要：
背景：与闭合性骨折相比，开放性胫骨骨折（OTF）的发病率和并发症风险大大增加。导致发病的最显著的OTF并发症通常被认为是骨折相关感染(FRI)。2016年9月，坦佩雷大学医院（TAUH）推出了基于BOAST4指南的OTF治疗方案。这项研究的目的是调查OTF治疗方案实施前后的结果。
方法：从2007年5月1日至2021年5月10日，使用来自TAUH患者记录数据库的精选数据进行了一项回顾性队列研究。对于OTF患者，我们收集了描述性信息，FRI和骨不连的已知危险因素，骨固定方法，可能的软组织重建方法，有关内固定时间和软组织覆盖的信息，和主要操作的时间。作为结果措施，我们收集了有关FRI的信息，由于不联合而再次手术，襟翼失效,和二次截肢。然后，我们比较了在TAUH实施OTF治疗方案前后的并发症发生率。
结果：在预定义排除之后，共纳入203例OTF患者.其中,在实施OTF治疗方案之前治疗141例，之后治疗62例。方案前方案组的FRI率明显高于方案组(20.6%vs1.6%,p=0.0015)。由于骨不连导致的再手术的发生率在方案前组中也显着较高（27.7％vs9.7％，p=0.0054）。根据多变量分析，在不同手术中进行的明确固定和软组织覆盖是FRI和由于骨不连而再次手术的独立危险因素.
结论：实施后，在研究期间,基于BOAST4的OTF治疗方案降低了在TAUH治疗的OTF患者由于骨不连导致的FRI和再手术率.我们,因此,建议在治疗OTF患者的所有主要创伤中心实施此类治疗方案。此外，我们还建议将复杂OTF患者从缺乏提供基于BOAST4治疗的先决条件的医院立即转诊至专业中心.
方法：从2007年5月1日至2021年5月10日，使用来自TAUH患者记录数据库的精选数据进行了一项回顾性队列研究。对于OTF患者，我们收集了描述性信息，FRI和骨不连的已知危险因素，骨固定方法，可能的软组织重建方法，有关内固定时间和软组织覆盖的信息，和主要操作的时间。作为结果措施，我们收集了有关FRI的信息，由于不联合而再次手术，襟翼失效,和二次截肢。然后，我们比较了在TAUH实施OTF治疗方案前后的并发症发生率。
结果：在预定义排除之后，共纳入203例OTF患者.其中,在实施OTF治疗方案之前治疗141例，之后治疗62例。方案前方案组的FRI率明显高于方案组(20.6%vs1.6%,p=0.0015)。由于骨不连导致的再手术的发生率在方案前组中也显着较高（27.7％vs9.7％，p=0.0054）。根据多变量分析，在不同手术中进行的明确固定和软组织覆盖是FRI和由于骨不连而再次手术的独立危险因素.
结论：实施后，在研究期间,基于BOAST4的OTF治疗方案降低了在TAUH治疗的OTF患者由于骨不连导致的FRI和再手术率.我们,因此,建议在治疗OTF患者的所有主要创伤中心实施此类治疗方案。此外，我们还建议将复杂OTF患者从缺乏提供基于BOAST4治疗的先决条件的医院立即转诊至专业中心.
