Fracturas expuestas de tibia en la Emergencia del Hospital Teodoro Maldonado Carbo y protocolo de atención de emergencia
No hay miniatura disponible
Fecha
2016
Autores
Título de la revista
ISSN de la revista
Título del volumen
Editor
Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Las fracturas expuestas son una de las lesiones más difíciles en el cuidado del
trauma y tienen un riesgo significativamente mayor de infección, pseudoartrosis,
complicaciones de cicatrización de la herida, y a menudo requieren múltiples cirugías
para el cuidado definitivo. El objetivo general fue diseñar un protocolo de atención de
emergencia de la fractura expuesta de tibia en pacientes del Hospital Regional IESS Dr.
Teodoro Maldonado Carbo. La metodología del estudio incluyó el enfoque cuantitativo,
fue de tipo observacional, retrospectivo y transversal, el periodo de estudio fue del 1 de
enero hasta el 30 de junio del 2016. Se utilizó estadística descriptiva e inferencial para el
análisis de la información. Del total de fracturas expuestas ( 56), el sexo masculino fue
el grupo poblacional mas afectado con el 70%, los adultos jóvenes entre 20-40 años de
edad representaron el 68% del total. Los traumatismo de alta energía (91%), por trauma
directo (100%) y los accidentes de tránsito (73%) fueron los predominantes. Según la
Clasificación de Gustillo-Anderson, las fracturas más comunes fueron las tipo II (38%)
y las III B (23%). Las lesiones de partes blandas estuvieron presentes en el 61% (34), la
más frecuentes fueron la pérdida de sustancia cutánea (45%). El tabaquismo (13%) y la
diabetes mellitus (9%) fueron los principales factores de riesgo. La infección de las partes
blandas y óseas (34%) fue la complicación predominante. Existió asociación
significativa entre las complicaciones con el sexo (p 0,001), factores de riesgo (p 0,0001),
etiología (p 0,001), complejidad de las fracturas (p 0,037) y el grado de exposición (p
0,001). La presencia de factores de riesgo duplica el riesgo de desarrollar complicaciones
[(RP: 2,10 (IC 95% 0,018-11,371)]. La complejidad de la fractura aumenta el riesgo 2
veces para desarrollar complicaciones [(2,943 (IC 95% 0,018-11,371). El grado de
exposición de la fractura es un factor de riesgo 2 veces mayor para presentar
complicaciones [2,801 (IC 95% 0,885-14,290)]. Se concluye que los pacientes adultos
jóvenes (20-40 años) de sexo masculino fueron el grupo poblacional más afectado por
ser el de mayor exposición a traumatismos de alta energía y las fractura expuesta grado
II y III B de Gustillo fueron la más frecuente, especialmente de trazo multifragmentario,
asociados a lesiones significativas de partes blandas. Además se encontró que las lesiones
de tejidos blandos influyen significativamente con el desarrollo de complicaciones y los
resultados funcionales.
Exposed fractures are one of the most difficult injuries in trauma care and have a significantly increased risk of infection, pseudoarthrosis, wound healing complications, and often require multiple surgeries for definitive care. The general objective was to design an emergency care protocol for the exposed tibial fracture in patients of the IESS Regional Hospital Dr. Teodoro Maldonado Carbo. The study was observational, retrospective and cross-sectional, the study period was from January 1 to June 30, 2016. Descriptive and inferential statistics were used for the analysis of the information. Of the total number of exposed fractures (56), the male sex was the most affected population group with 70%, young adults between 20-40 years of age accounted for 68% of the total. High-energy trauma (91%), direct trauma (100%), and traffic accidents (73%) were the predominant ones. According to the Gustillo-Anderson classification, the most common fractures were type II (38%) and III B (23%). Soft tissue lesions were present in 61% (34), the most frequent being loss of cutaneous substance (45%). Smoking (13%) and diabetes mellitus (9%) were the main risk factors. Infection of the soft and bony parts (34%) was the predominant complication. There was a significant association between complications with sex (p 0.001), risk factors (p 0.0001), etiology (p 0.001), fracture complexity (p 0.037) and degree of exposure (p 0.001). The presence of risk factors doubles the risk of developing complications (RP: 2.10 (95% CI 0.018-11.371).) The complexity of the fracture increases the risk 2-fold to develop complications [(2,943 (95% CI 0.018 The degree of exposure of the fracture is a 2-fold higher risk factor for complications [2,801 (95% CI 0.885-14.290)] It is concluded that young adult (20-40 years) male patients Were the most affected population due to the higher exposure to high-energy trauma and Gustillo's grade II and III B fractures were the most frequent, especially multifragmentary traces, associated with significant soft tissue injuries. Soft tissue lesions significantly influence the development of complications and functional outcomes.
Exposed fractures are one of the most difficult injuries in trauma care and have a significantly increased risk of infection, pseudoarthrosis, wound healing complications, and often require multiple surgeries for definitive care. The general objective was to design an emergency care protocol for the exposed tibial fracture in patients of the IESS Regional Hospital Dr. Teodoro Maldonado Carbo. The study was observational, retrospective and cross-sectional, the study period was from January 1 to June 30, 2016. Descriptive and inferential statistics were used for the analysis of the information. Of the total number of exposed fractures (56), the male sex was the most affected population group with 70%, young adults between 20-40 years of age accounted for 68% of the total. High-energy trauma (91%), direct trauma (100%), and traffic accidents (73%) were the predominant ones. According to the Gustillo-Anderson classification, the most common fractures were type II (38%) and III B (23%). Soft tissue lesions were present in 61% (34), the most frequent being loss of cutaneous substance (45%). Smoking (13%) and diabetes mellitus (9%) were the main risk factors. Infection of the soft and bony parts (34%) was the predominant complication. There was a significant association between complications with sex (p 0.001), risk factors (p 0.0001), etiology (p 0.001), fracture complexity (p 0.037) and degree of exposure (p 0.001). The presence of risk factors doubles the risk of developing complications (RP: 2.10 (95% CI 0.018-11.371).) The complexity of the fracture increases the risk 2-fold to develop complications [(2,943 (95% CI 0.018 The degree of exposure of the fracture is a 2-fold higher risk factor for complications [2,801 (95% CI 0.885-14.290)] It is concluded that young adult (20-40 years) male patients Were the most affected population due to the higher exposure to high-energy trauma and Gustillo's grade II and III B fractures were the most frequent, especially multifragmentary traces, associated with significant soft tissue injuries. Soft tissue lesions significantly influence the development of complications and functional outcomes.
Descripción
PDF
Palabras clave
FRACTURAS EXPUESTAS, FRACTURAS DE LA TIBIA, SERVICIO DE EMERGENCIA DEL HOSPITAL, PROTOCOLOS, ATENCION AL PACIENTE, ESTUDIOS RETROSPECTIVOS, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR