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Войти в исследования OTA international : the open access journal of orthopaedic trauma · 2026
Continuous local antibiotic perfusion therapy: a prophylactic strategy for Gustilo-Anderson type III open fractures.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Nakagawa Shota, Kudo Toshiya, Cortez Kiko A, Shibata Ryutaro, Sano Yoshitomo, Minehara Hiroaki, Sawaguchi Takeshi, Matsushita Takashi
Аннотация
OBJECTIVES: Managing Gustilo-Anderson type III open fractures remains a challenge in orthopaedic trauma. Continuous local antibiotic perfusion (CLAP) therapy serves as a potential adjunct for infection prevention. In this study, the authors evaluated the clinical outcomes in patients with Gustilo-Anderson type III open fractures treated using an orthoplastic approach with CLAP therapy.
DESIGN: Single-center retrospective review.
SETTING: Tertiary trauma and reconstruction center (2020-2023).
PATIENTS/PARTICIPANTS: Twenty-two patients (mean age, 54.8 years) with Gustilo-Anderson type III open fractures of the extremities were included.
INTERVENTION: All patients received CLAP therapy with gentamicin as an adjunct to systemic antibiotics, staged fixation, and orthoplastic soft tissue management.
MAIN OUTCOME MEASUREMENTS: Data included demographics, injury and hospitalization details, type of fixation and coverage, CLAP therapy dosage, union rate, time-to-union, and CLAP therapy-related complications.
RESULTS: Two patients (9%) developed infections within 9 months. Primary union was achieved in 20 patients (91%); the remaining 2 achieved union after secondary bone grafting (overall 100%). The mean time-to-union was 6.4 months, and the mean follow-up duration was 21.5 months. No systemic adverse effects attributable to CLAP therapy were observed.
CONCLUSIONS: CLAP therapy, as an adjunct to intravenous antibiotics, debridement, soft tissue reconstruction, and staged fixation, resulted in a relatively low infection rate (9%) in a small (22 patients) series of Gustilo-Anderson type III open fractures and was associated with a high union rate (91% primary, 100% with secondary surgery) and no recognized complications directly attributable to CLAP therapy. However, the absence of a control group precludes conclusions regarding comparative effectiveness.
LEVEL OF EVIDENCE: Level IV.
DESIGN: Single-center retrospective review.
SETTING: Tertiary trauma and reconstruction center (2020-2023).
PATIENTS/PARTICIPANTS: Twenty-two patients (mean age, 54.8 years) with Gustilo-Anderson type III open fractures of the extremities were included.
INTERVENTION: All patients received CLAP therapy with gentamicin as an adjunct to systemic antibiotics, staged fixation, and orthoplastic soft tissue management.
MAIN OUTCOME MEASUREMENTS: Data included demographics, injury and hospitalization details, type of fixation and coverage, CLAP therapy dosage, union rate, time-to-union, and CLAP therapy-related complications.
RESULTS: Two patients (9%) developed infections within 9 months. Primary union was achieved in 20 patients (91%); the remaining 2 achieved union after secondary bone grafting (overall 100%). The mean time-to-union was 6.4 months, and the mean follow-up duration was 21.5 months. No systemic adverse effects attributable to CLAP therapy were observed.
CONCLUSIONS: CLAP therapy, as an adjunct to intravenous antibiotics, debridement, soft tissue reconstruction, and staged fixation, resulted in a relatively low infection rate (9%) in a small (22 patients) series of Gustilo-Anderson type III open fractures and was associated with a high union rate (91% primary, 100% with secondary surgery) and no recognized complications directly attributable to CLAP therapy. However, the absence of a control group precludes conclusions regarding comparative effectiveness.
LEVEL OF EVIDENCE: Level IV.