JBJS -- Letters to the Editor for Skaggs et al., 87 (1) 8-12

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Letters to the Editor to:

Scientific Articles:
David L. Skaggs, Lauren Friend, Benjamin Alman, Henry G. Chambers, Michael Schmitz, Brett Leake, Robert M. Kay, and John M. Flynn
The Effect of Surgical Delay on Acute Infection Following 554 Open Fractures in Children
J Bone Joint Surg Am 2005; 87: 8-12 [Abstract] [Full text] [PDF]

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Electronic letters published:

Dr. Skaggs responds to Dr. Rodop: David L. Skaggs (21 November 2005)

Surgical Delay in Treating Open Fractures in Children: Osman Rodop, Can Solakoglu, Ahmet Kiral, Mahir Mahirogulları, Mesih Kuskucu (21 November 2005)

Dr. Skaggs responds to Dr. Rodop 21 November 2005

David L. Skaggs,
Associate Director
Childrens Orthopaedic Center, Childrens Hospital of Los Angeles, Los Angeles, CA 90027
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Re: Dr. Skaggs responds to Dr. Rodop

dskaggs{at}chla.usc.edu David L. Skaggs

Thank you for your letter. I will respond to each of your points:
1. Thank you for the additional references.
2. In the methods section it states that fractures were consecutive, excluding only those children who died or had gunshot wounds. Thus, all other types of fractures were included in this study.
3. This point is correct, the reader could miss this sentence. I am not certain, however, that it would be good writing to repeat sentences in case the reader misses it the first time.
4. Along with the type of antibiotic given, there are many other factors not fully investigated in this study. This study was focused to answer one question as stated.
5. We share your concern.

Surgical Delay in Treating Open Fractures in Children 21 November 2005

Osman Rodop,
Associated Professor in Orthopedics & Traumatology
GATA Haydarpasa Training Hospital, Istanbul, TURKEY,
Can Solakoglu, Ahmet Kiral, Mahir Mahirogulları, Mesih Kuskucu
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Re: Surgical Delay in Treating Open Fractures in Children

rodop62{at}yahoo.com Osman Rodop, et al.

To the Editor:
We would like to thank Drs. Skaggs and colleagues for this study but we have several objections:
1. The authors state that there are no previous articles about the advantages of early surgical debridement; however, we would note that there are several studies in the literature (1,2,3,4).
2. The authors have not stated the nature of the open wounds. It is not certain in the text whether highly contaminated injuries like barnyard injuries or lawn mover injuries, are included in the study.
3. Gunshot wounds, which constitute a considerable number of open fractures in the States, are not included in the study. This is mentioned in only one sentence in the text and the reader can easily miss this important detail.
4. The type of antibiotics used is not given in the text. The antibiotic selection can affect the course of treatment and early debridement decreases the need for broad-spectrum antibiotics especially for anaerobic bacteria, which could be quite costly.
5. We are concerned that this article can easily mislead young orthopedic surgeons to treat open fractures only with early antibiotics and delay debridement for more than 24 hours, a treatment regimen which we feel could be detrimental to a child’s health especially in highly contaminated open fractures.
References:
1. Infections caused by lawn mower injuries in children Richard Sadovsky. American Family Physician. Kansas City: Aug 15, 2001.Vol.64, Iss. 4; pg. 674, 2 pgs
2. Open fracture of the tibia in children. Cullen MC, Roy DR, :. Crawford J Bone Joint Surg Am. 1996 Jul;78(7):1039-47AH, Assenmacher J, Levy MS, Wen D.
3. Pediatric orthopedic trauma: Principles in management Douglas S. Musgrave, MD; Stephen A. Mendelson, MD Crit Care Med 2002 Vol. 30, No. 11 (Suppl.)
4. The Effect of Time to Definitive Treatment on the Rate of Nonunion and Infection in Open Fractures Brian J. Harley, Lauren A. Beaupre, C. Allyson Jones, Sukhdeep K. Dulai, and Donald W. Weber Journal of Orthopaedic Trauma Vol. 16, No. 7, pp. 484–490 © 2002 Lippincott Williams & Wilkins, Inc., Philadelphia.