Consensus Questions

  • Pre-hospital/ Emergency care
  • Irrigation and Debridement
  • Antibiotics
  • Scoring
  • Skeletal fixation
  • Soft tissue cover
  • Outcomes
  • VTE prophylaxis

Pre-hospital/ Emergency care

QUESTIONS
DOCTORS
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1 Should tranexamic acid (TXA) be administered pre-hospital in patients with open fractures with active bleeding?
Dr.Christian Fang, Dr.Chetan Pradhan, Dr.Arvind
2 In open fractures, is compartment pressure monitoring essential in uninvolved compartments?
Dr.Jae-Woo Cho, Dr.Siddharth Sharma, Dr.K P Srikkanth
3 Should immediate reduction of protruding bone fragments or open dislocations be attempted in the emergency department prior to formal debridement?
Dr.Antonio Gardner, Dr.Ajith Kumar, Dr.Rajabhaskar
4 Should preliminary wound irrigation with saline be performed in the emergency department prior to surgical debridement?
Dr.Roman Pfifer, Dr.Lalit Maini, Dr.BRW Armstrong
5 Can regional anaesthesia be used in patients for pain relief before transfer to the operating theatres for debridement?
Dr.S Raja Sabapathy, Dr.Venkateshwaran, Dr.Mounusha
6 Is human tetanus immunoglobulin mandatory in all cases of open fracture?
Dr.Michel Teuben, Dr.Unmesh Chakravarthy, Dr.Mohammed Zackariya
7 Does a delay in surgical debridement beyond the traditional “six-hour window” independently increase the risk of deep infection?
Dr.Christian Fang, Dr.Chetan Pradhan, Dr.Arvind
8 In Gustilo Grade III injuries, is it acceptable to delay debridement beyond six hours in order to await an experienced surgical team?
Dr.Fareed Kagda, Dr.Singaravadivelu, Dr.Gokul Dev
9 Should debridement be deferred until serum lactate has normalised in polytrauma or isolated long bone open fractures?
Dr.Chris Hans Pape, Dr.Vivek Trikha, Dr.Keerthan
10 Should the timing of surgical debridement differ between low-energy and high-energy open injuries?
Dr.Hayder Al Saadi, Dr.Thirunarayanan, Dr.Harsha
11 Does the use of a pneumatic tourniquet reduce blood loss and improve the quality of debridement?
Dr.Ravindra Bharathi, Dr.Vamseedharan Muthukumar, Dr.Roopesh
12 Is the routine use of surgical magnification (e.g., loupes) recommended to enhance visualisation and improve debridement quality?
Dr.Ravindra Bharathi, Dr.Vamseedharan Muthukumar, Dr.Roopesh
13 Is chlorhexidine or povidone-iodine the preferred solution for disinfecting extruded bony fragments prior to reimplantation?
Dr.Thierry Beque, Dr.Sushruth Babhulkar, Dr.Mohammed Asrar
14 Is there a minimum volume of saline required for effective debridement?
Dr.Antonio Gardner, Dr.Ajith Kumar, Dr.Rajabhaskar
15 Is there a role for pulsatile lavage during debridement of open injuries?
Dr.Kevin Tetsworth, Dr.Shailesh pai, Dr.Sahith
16 Is a routine “second-look” debridement at 48 hours mandatory in severe Grade III or crush injuries?
Dr.Rodrigo Pesantez, Dr.Dhaval Desai, Dr.Aditya Yagnik
17 Does photodynamic disinfection (light-activated antimicrobial therapy) represent a promising adjunct for decontamination of devitalised tissue?
Dr.Chris Hans Pape, Dr.Vivek Trikha, Dr.Keerthan
18 Should techniques such as laser fluorescence or indocyanine green angiography be routinely utilised to assess soft tissue viability during debridement?
Dr.Michel Teuben, Dr.Unmesh Chakravarthy, Dr.Mohammed Zackariya
19 In patients with contaminated open fractures, does ultrasonic debridement compared with conventional manual curettage improve decontamination?
Dr.Roman Pfifer, Dr.Lalit Maini, Dr. BRW Armstrong
20 Is aggressive initial debridement superior to tissue-preserving strategies?
Dr.Hari Venkatramani, Dr.Romi, Dr.Senthil Velan
21 Can we objectively assess the quality of debridement in open injuries?
Dr.Emmanouil Liodakis, Dr.Ashok Gavaskar, Dr.Thiaghu
22 Are mechanical suction drains effective for dead space management following debridement?
Dr.Marinis Pirpiris, Dr.Anup Agrawal, Dr.Terrence Jose Jerome, Dr.Surendran G
23 Is the establishment of an orthoplastic service compelling in contemporary practice?
Dr.S Raja Sabapathy, Dr.Venkateshwaran, Dr.Mounusha
24 Is a mangled extremity appropriately defined as simultaneous injury to at least three of the following components: skeletal, vascular, soft tissue, and neural structures?
Dr.Ronald Wong, Dr.Vasudeva Juvvadi, Dr.Muthukumar
25 Should the decision between limb salvage and amputation always involve two consultants?
Dr.Ronald Wong, Dr.Vasudeva Juvvadi, Dr.Muthukumar
26 Is posterior tibial nerve injury an indication for amputation?
Dr.Hari Venkatramani, Dr.Romi, Dr.Senthil Velan
27 Should antibiotic-containing irrigation solutions be routinely employed?
Dr.Hayder Al Saadi, Dr.Thirunarayanan, Dr.Harsha
28 Should prophylactic antibiotic administration be limited to a single dose, or continued for up to 72 hours?
Dr.Carlos Valderrama, Dr.Neeraj Bijilani, Dr.Sanjana
29 In patients undergoing delayed soft tissue coverage, should antibiotic therapy be continued until definitive closure is achieved?
Dr.Peter Giannoudis, Dr.Durgaprasad Valleri, Dr.Rakesh
30 In patients requiring multiple staged reconstructive procedures, should antibiotic therapy be administered intermittently or continuously until the final stage?
Dr.Mario Morgenstern, Dr.Sujit Kumar Tripathy, Dr.Lester frank
31 Does the placement of an antibiotic cement spacer confer benefit for dead space management in segmental bone defects following debridement?
Dr.Marinis pirpiris, Dr.Anup Agrawal, Dr.Terrence Jose Jerome, Dr.Surendran G
32 Do open pelvic injuries require a different antibiotic protocol?
Dr.Zsolt Balogh, Dr.Sithombo Maqungo, Dr.Abhay Elhence, Dr.Imran Asif
33 Is there a routine role for local antibiotic delivery in the management of open fractures?
Dr.Kevin Tetsworth, Dr.Shailesh pai, Dr.Sahith
34 In patients with uncontrolled diabetes mellitus, should the duration of antibiotic therapy be extended until wound healing is achieved?
Dr.Jae-Woo Cho, Dr.Siddharth Sharma, Dr.K P Srikkanth
35 In farmyard-related open injuries, should empirical antibiotic regimens include antifungal agents in addition to anaerobic coverage?
Dr.Khaleed Emara, Dr.K C Sreekanth, Dr.Praveen
36 Should IV cefuroxime be adopted as the standard prophylactic antibiotic, or should antibiotic selection be guided by local hospital protocol?
Dr.Vikas Agashe, Dr.Adithya Menon, Dr.Arun kamal
37 Is there a role for oral antibiotics following primary surgical debridement of open injuries?
Dr.Ramasubramanyam, Dr.V.M Balasubramani, Dr.Sivakumar SP
38 Should cultures be obtained prior to every stage of reconstruction?
Dr.Vikas Agashe, Dr.Adithya Menon, Dr.Arun kamal
39 Is the Gustilo–Anderson classification system still a valid tool for classifying open injuries?
Dr.Sunny Parikh, Dr.Shanmukha Babu, Dr.Roopesh
40 Is there a clear preference regarding the choice of scoring systems in open injuries?
Dr.Ramesh P, Dr.Navin Thakkar, Dr.Srinivas kambhampati
41 Should open fractures only be definitively classified after surgical debridement rather than in the ER?
Dr.S Rajasekaran, Dr.Jamal Ashraf, Dr.Sindhura Yamajala, Dr.Suriyan
42 Can existing open injury classification systems be reliably extrapolated to upper limb injuries?
Dr.Martin Jaegger, Dr.Venkatadas, Dr.Stefano Conti, Dr.Aadhavan
43 Can existing open injury scores be applied to paediatric populations?
Dr.Martin Jaegger, Dr.Venkatadas, Dr.Stefano Conti, Dr.Aadhavan
44 Are existing classification systems adequate for characterising open pelvic injuries?
Dr.Zsolt Balogh, Dr.Sithombo Maqungo, Dr.Abhay Elhence, Dr.Imran Asif
45 Are current classification and scoring systems adequate for predicting limb salvage versus amputation?
Dr.Sunny Parikh, Dr.Shanmukha Babu, Dr.Roopesh
46 In segmental bone defects measuring less than 4 cm, is acute limb shortening to facilitate wound closure, followed by distraction osteogenesis, an acceptable strategy?
Dr.Marco Berlusconi, Dr.Ashok Shyam, Dr.Pushkar Chawla, Dr.Mouli Chandar
47 Is there a definitive role for circular (ring) external fixators in the acute management of open injuries with bone loss?
Dr.Devendra, Dr.Milind Chaudhary, Dr.Govardhan, Dr.Raahul, Dr.Arjun
48 In open injuries with segmental bone defects, is the Masquelet technique preferable to distraction osteogenesis?
Dr.Peter Giannoudis, Dr.Durgaprasad Valleri, Dr.Rakesh
49 Is primary autologous bone grafting recommended for critical bone defects following adequate debridement and stabilisation?
Dr.S Rajasekaran, Dr.Jamal Ashraf, Dr.Sindhura Yamajala, Dr.Suriyan
50 Is 14 days an absolute safe interval for conversion from external fixation to internal fixation?
Dr.N.K.Kanakaris, Dr.Owais Ahemad, Dr.Ashutosh
51 Should early conversion from external to internal fixation be guided by serum procalcitonin trends rather than fixed time intervals?
Dr.N.K.Kanakaris, Dr.Owais Ahemad, Dr.Ashutosh
52 Is bone transport (distraction osteogenesis) performed underneath a flap, a safe and effective primary management for bone defects?
Dr.Dheenadhayalan, Dr.Vetrivel Chezian, Dr.Nagashree V, Dr.Varsha
53 In open injuries with segmental bone loss, should primary stabilisation using a Limb Reconstruction System (LRS) be preferred over conventional external fixation?
Dr.Dheenadhayalan, Dr.Vetrivel Chezian, Dr.Nagashree V, Dr.Varsha
54 Are there well-defined criteria for performing definitive internal fixation immediately after index debridement?
Dr.Emmanouil Liodakis, Dr.Ashok Gavaskar, Dr.Thiaghu
55 Should vascular shunting be performed prior to definitive bone fixation to minimise warm ischaemia time, or should it follow bony fixation?
Dr.Vincenzo Giordano, Dr.Samarth Mittal, Dr.Harish
56 In major crush injuries of the upper limb, should limb salvage be prioritised due to the limited availability of prosthesis?
Dr.Alvaro Zamorano, Dr.Kateros Konstantinos, Dr.Sibin, Dr.Rithabh kumar
57 Can critically important extruded articular bone fragments (e.g., talus or femoral condyle), retrieved from the injury site despite contamination, be safely reimplanted following appropriate decontamination?
Dr.Fareed Kagda, Dr.Singaravadivelu, Dr.Gokul Dev
58 In open injuries that have undergone adequate debridement, is primary wound closure acceptable in the absence of skin loss?
Dr.Rahat Jarayabhand, Dr.Rajiv Chatterjee, Dr.Velmurugesan, Dr.Thirumurugan
59 Which local flap procedures should all orthopaedic trauma surgeons be trained to perform in emergencies?
Dr.Rajendra Nahate, Dr.Praveen Bharadwaj, Dr.Vigneshwaran
60 When used as a bridge to definitive closure, does NPWT significantly reduce infection risk compared with saline-soaked gauze dressings?
Dr.Ahmad Arief, Dr.Raju Iyyengar, Dr.Imran Asif
61 Can biological dressings (e.g., temporary skin substitutes) effectively prevent cortical bone necrosis while awaiting definitive flap coverage?
Dr.Rajendra Nahate, Dr.Praveen Bharadwaj, Dr.Vigneshwaran
62 Should 72 hours be regarded as the cut-off when distinguishing “early” from “delayed” soft tissue coverage?
Dr.Rahat Jarayabhand, Dr.Velmurugesan, Dr.Rajiv Chatterjee, Dr.Thirumurugan
63 Is there a role for simultaneous fix and flap in open injuries?
Dr.Devendra A, Dr.Milind Chaudhary, Dr.Govardhan, Dr.Raahul, Dr.Arjun
64 What constitutes the optimal suction pressure and duration in NPWT?
Dr.Alvaro Zamorano, Dr.Kateros Konstantinos, Dr.Sibin, Dr.Rithabh kumar
65 What is the role of continuous irrigation with negative pressure dressings designed for instillation therapy?
Dr.Mario Morgenstern, Dr.Sujit Kumar Tripathy, Dr.Lester frank
66 Should outcome registries for open fractures be globally standardised to enhance the accuracy of prognostic models?
Dr.Thierry Beque, Dr.Sushruth Babhulkar, Dr.Mohammed asrar
67 Should return to work status be utilised as a primary outcome measure in open fractures?
Dr.Vincenzo Giordano, Dr.Samarth Mittal, Dr.Harish
68 Should patient-reported outcome measures (PROMs) be prioritised over objective clinical metrics in assessing the success of limb salvage?
Dr.Wael Taha, Dr.Santosh Ram Gaddam, Dr Hemraj Bhaskar
69 Is the long-term functional outcome following early amputation superior to that of delayed amputation after failed limb salvage?
Dr.Marco Berlusconi, Dr.Ashok Shyam, Dr.Pushkar Chawla, Dr.Mouli Chandar
70 Does concomitant traumatic brain injury significantly accelerate fracture union in open injuries?
Dr.Ramesh P, Dr.Navin Thakkar, Dr.Srinivas kambhampati
71 Are low-dose heparin, aspirin, or apixaban equally effective alternatives to low molecular weight heparin (LMWH) for VTE prophylaxis following fixation of open fractures?
Dr.Carlos Valderrama, Dr.Neeraj Bijilani, Dr.Sanjana
72 Are mechanical prophylactic measures (e.g., intermittent pneumatic compression devices applied to the uninjured limb) sufficient as sole VTE prevention during the acute phase of open fracture management?
Dr.Wael Taha, Dr.Santosh Ram Gaddam, Dr.Hemraj Bhaskar