Current Practice in the Management of Type I Open Fractures in XXXX : A Survey of POSNA Membership.

@entity174 @entity1 @entity4207 @entity4422
BACKGROUND:: Treatment of pediatric type I @entity4422 is controversial. Centers have reported good success with emergency room (ER) treatment of low-energy (type I) open pediatric @entity174 . The purpose of this study was to ascertain the treatment preferences of pediatric orthopaedic surgeons for type I @entity4422 . We hypothesize that surgeons will have different treatment protocols and preferred location for these injuries. METHODS:: A questionnaire was given to Pediatric Orthopaedic Society of North America (POSNA) members at the 2012 annual meeting. Demographic questions inquired about surgeon's practice environment and experience, whereas clinical questions queried opinions regarding the typical treatments and past experiences with @entity4422 . Clinical scenarios questioned preferred management of @entity4422 . RESULTS:: A total of 181 surveys were collected from the 503 POSNA members in attendance (36%). Years in practice were well represented with 34%: <10 years, 37%: 10 to 19 years, and 29%: >20 years. Most respondents' practices comprised over 80% pediatric @entity1 (86%), were @entity4207 (68%), and worked with residents (77%). After initial treatment of an open @entity174 , 86% of respondents admitted @entity1 for intravenous antibiotics and 57% gave oral antibiotics. There was no consensus regarding the amount or type of irrigation preferred, use of antibiotics in the irrigation, or whether the bone ends are delivered during irrigation and d  bridement. Soft-tissue infections and delayed union were noted by 13% and 8%, respectively, of respondents in type I @entity4422 treated in the ER and in 16% and 30% treated in the operating room (OR). ER treatment was preferred in 19% to 31% of respondents for type I @entity4422 . When queried if level 1 evidence existed that demonstrated equivalent results between ER and OR management, 92% of respondents would change their practice. CONCLUSIONS:: Treatment methods of type I @entity4422 are variable. Many surgeons prefer to treat type I @entity4422 in the ER as opposed to the traditional OR irrigation and d  bridement. On the basis of this survey, either @entity1 are going to the OR when ER treatment would be adequate or they may be receiving inadequate care when they avoid OR management. This survey establishes the equipoise necessary for a randomized, prospective trial comparing ER and OR management in the treatment of pediatric type I @entity4422 . LEVEL OF EVIDENCE:: This study is level V evidence reviewing trends in the management of type I @entity4422 in @entity1 . POSNA membership represents various levels of expertise in their preferred treatment method.
