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J Trauma Inj > Epub ahead of print
DOI: https://doi.org/10.20408/jti.2020.0043    [Epub ahead of print]
Published online March 15, 2021.
The Effects of a Trauma Team Approach on the Management of Open Extremity Fractures in Polytrauma Patients: A Retrospective Comparative Study
Seungyeob Sakong1, Eic Ju Lim1, Jun-Min Cho2, Nak-Jun Choi2, Jae-Woo Cho1, Jong-Keon Oh1
1Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
2Department of General Surgery, Korea University Guro Hospital, Seoul, Korea
Correspondence:  Jong-Keon Oh, Tel: +82-2-2626-1114, 
Email: jkoh@korea.ac.kr
Received: 25 August 2020   • Revised: 1 December 2020   • Accepted: 9 December 2020
Abstract
Purpose
Open extremity fractures require prompt antibiotic medication and initial debridement surgery to reduce the infection rate and restore functional stabilization. We aimed to report the effects and positive outcomes of a trauma team approach on the management of open extremity fractures in polytrauma patients.
Methods
This retrospective review included all polytrauma patients with open extremity fractures admitted between March 2009 and December 2019. Patients were divided into two groups according to whether they were treated before or after the implementation of the trauma team approach (March 2014). We analyzed the outcomes in each group with respect to the time interval until the doctor’s arrival, total length of stay in the emergency department, the time interval until initial antibiotic treatment and operation, whether the initial operation was performed within 24 hours, and the rate of deep infections.
Results
A total of 123 patients met the inclusion criteria. There were no statistically significant differences in demographic characteristics. The time interval until the doctor’s arrival (64.12±49.2 minutes vs. 19.82±15.23 minutes; p=0.035) and initial antibiotic treatment (115.47±72.12 minutes vs. 48.78±30.12 minutes; p=0.023) significantly improved after implementing the trauma team approach. The union rate was not significantly different. However, the time interval until initial debridement, opportunity for initial debridement within 24 hours, and the rate of deep infections demonstrated better results.
Conclusions
The reduced time interval until initial antibiotic treatment and debridement could be attributed to the positive effect of the trauma team approach on the management of open extremity fractures in polytrauma patients.
Key Words: Open fracture; Multiple trauma; Trauma team approach


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