What management is required for a patient with a right neck of femur fracture post Operative Reduction and Internal Fixation (ORIF) who is still oozing from the wound site and not weight bearing?

From the Guidelines

The patient with a right neck of femur fracture post-ORIF who is still oozing from the wound site and not weight bearing should be managed with daily sterile dressing changes, pain management, mobilization, and prevention of complications, with a focus on wound care and prevention of infection, as guided by the most recent evidence from the AAOS clinical practice guideline summary 1. The management plan should include:

• Daily sterile dressing changes using chlorhexidine or povidone-iodine solution, followed by application of sterile gauze and securing with hypoallergenic tape
• Pain management with scheduled acetaminophen 1000mg every 6 hours, supplemented with tramadol 50mg every 6 hours as needed for breakthrough pain
• Physical therapy with non-weight bearing exercises, including ankle pumps, quadriceps sets, and gluteal squeezes, performed 10 repetitions 3 times daily
• Use of a walker or crutches for transfers and mobility while maintaining strict non-weight bearing status on the affected limb for 6-8 weeks as typically prescribed
• Deep vein thrombosis prophylaxis with enoxaparin 40mg subcutaneously daily for 28-35 days post-surgery
• Regular monitoring of hemoglobin levels due to the wound oozing, and iron supplementation if anemia develops It is essential to note that wound oozing is common in the early postoperative period, but persistent drainage requires vigilance to prevent infection, which could compromise the surgical outcome, as highlighted in the study on pathogenesis and management of fracture-related infection 1. The AAOS clinical practice guideline summary 1 recommends considering postoperative negative pressure wound therapy (NPWT) for high-risk surgical incisions, although its use is influenced by cost considerations. In the absence of clear evidence, a consensus was reached recommending preoperative decolonization protocols, including nasal deconization and skin decolonization, to decrease bacterial colonization on the patient before surgery 1.

From the Research

Management of Wound Oozing and Non-Weight Bearing Post ORIF

• The patient's condition of oozing from the wound site and not weight bearing after ORIF for a right neck of femur fracture requires careful management to prevent infection and promote healing.
• According to 2, negative pressure wound therapy with instillation (NPWTi) can be effective in managing wounds with high complication rates, although this study focused on necrotizing soft tissue infections.
• The use of antibiotics may also be necessary to prevent infection, as discussed in 3, which highlights the importance of broad-spectrum antibiotic therapy in managing necrotizing soft tissue infections.
• Advanced wound care strategies, including dressing materials and modalities such as negative pressure wound therapy, may be beneficial in promoting wound healing, as outlined in 4.
• Debridement methods, including autolysis and surgical debridement, can be used to remove necrotic tissue and promote healing, as discussed in 5 and 6.

Considerations for Non-Weight Bearing

• The patient's inability to weight bear may require additional support and rehabilitation to prevent further complications and promote recovery.
• Early mobilization and physical therapy can be beneficial in promoting healing and preventing long-term disability.
• The use of assistive devices, such as walkers or crutches, may be necessary to support the patient's mobility and prevent further injury.

Infection Prevention and Management

• Close monitoring of the patient's condition is necessary to prevent infection and promote healing.
• The use of antibiotics and advanced wound care strategies can help prevent infection and promote wound healing.
• Early recognition and management of any signs of infection, such as increased redness, swelling, or purulent discharge, are critical to preventing serious complications.