Is nonoperative treatment of pediatric type I open fractures safe and effective?

Objectives: To evaluate the management of tibial diaphyseal fractures treated byPOP cast versus intramedullary nailing in terms of time of union. Design of study: Randomizedcontrolled trials. Setting: Department of Orthopaedic, Allied / DHQ Hospital, Faisalabad.Duration of Study: Six months (01-08-2013 to 31-01-2014). Materials and Methods: 80patients fulfilling the inclusion and exclusion criteria were included in the study. After laboratoryand radiological assessment, the patients in Group 1 were treated by long leg cast. The patientsin Group 2 were treated with intramedullary interlocking nail. The patients were followed on OPDbasis. Results: 80 patients divided into 2 groups. Each group had 40 patients. Mean age ofpatients was 30.99 ±8.092 years. There were total of 65% males and 35% females in this study.According to geometry of fractures simple transverse fractures were 47.5%, spiral fractureswere 17.5%, oblique fractures were 25% and segmental fractures were 10%. There were 71.25%closed fracture and 28.75% type l open fractures. Mean time of union was 23.86 ± 5.48 weeks ingroup 1 while in group 2, mean time of union was 18.35 ± 4.12 weeks. P-value was 0.001 whichis statistically significant. Conclusion: It is concluded that reamed intramedullary interlockingnailing is a good mode of internal fixation comparing with conservative management of closereduction and POP cast in both close and type I open fractures in terms of union.

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Effectiveness of Non-operative Treatment of Symptomatic Accessory Navicular in Pediatric Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00346 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0034

Author(s):

Malynda Messer ◽

Candice Brady ◽

Kristin Cola ◽

Jaime Rice-Denning

Keyword(s):

Pain Relief ◽

Operative Treatment ◽

Pediatric Patients ◽

Surgical Intervention ◽

Treatment Options ◽

Nonoperative Treatment ◽

Type I ◽

First Line ◽

Complete Pain Relief ◽

Accessory Navicular

Category: Midfoot/Forefoot Introduction/Purpose: Initial management of symptomatic accessory naviculae in pediatric patients is nonoperative. Common first line treatments include casting, shoe wear modification, limiting strenuous activities, and nonsteroidal anti-inflammatories. When nonoperative treatments fail to mitigate symptoms, surgery is indicated. Surgical treatment of symptomatic accessory navicular bones has been extensively studied. However, the efficacy of nonoperative treatment for alleviating pain or preventing surgery in effected patients has not been established. We believe that nonoperative treatment is frequently unsuccessful or does not give lasting pain relief, thus questioning whether surgery could be offered as first line treatment. Our study retrospectively reviews outcomes of adolescents treated non-operatively for symptomatic accessory naviculae in an effort to provide clinicians success rates for their discussion of treatment options with patients and their families. Methods: This is an IRB approved, retrospective study of adolescent patients diagnosed and treated non-operatively for symptomatic accessory navicular bones at Cincinnati Children’s Hospital Medical Center between the dates 8/1/2006 and 8/24/2016. Medical records were used to identify demographic information, type, duration, and total trials of conservative treatment, additional foot comorbidities, response to conservative management, and surgery if non-operative management failed. Included patients were under 18 years of age with medial sided foot pain, radiographic evidence of an accessory navicular, and had undergone at least 1 course of non-operative treatment. Patients with previously operated on accessory naviculars or other diagnosed painful foot conditions were excluded. Outcome measures consisted of pain relief, no surgical intervention, or need for surgical intervention. Available radiographic imaging for each patient was also used to identify type of accessory navicular and determine pes planus incidence. Statistical analysis using measures of central tendency was then performed. Results: 169 patients were included, with 226 symptomatic accessory naviculae. Average age at diagnosis was 11.8 years, with 78.2% females, and 22% males. 53 (32%) were left symptomatic accessory naviculae, 56 (33%) right, and 60 (36%) bilateral. Type II accessory naviculae were most frequent (72.7%), with Type I and Type III in 9.7% and 17.4%, respectively. 56% were chronic in nature, with 31% due to acute injury. Average number of non-operative trials was 2.08, with 28% experiencing complete pain relief, 30% requiring surgical intervention, and 41% that did not require surgical intervention, but were without documented pain relief. Of those that achieved complete pain relief, average length of non-operative treatment was 8.03 months. Conclusion: Results of this study can be used by clinicians to frame discussions surrounding treatment options for symptomatic accessory navicular bones with both patients and their families. Further research is warranted to determine the necessary duration and type of non-operative treatment, among those most commonly used, that is most successful in providing pain relief.

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Calcaneal Malunions: Results of a Prognostic Computed Tomography Classification System

Foot & Ankle International ◽

10.1177/107110079601700707 ◽

1996 ◽

Vol 17 (7) ◽

pp. 395-401 ◽

Cited By ~ 100

Author(s):

Heidi Multhopp Stephens ◽

Roy Sanders

Keyword(s):

Computed Tomography ◽

Classification System ◽

Prognostic Significance ◽

Lateral Wall ◽

Nonoperative Treatment ◽

Type I ◽

Posttraumatic Arthritis ◽

Significant Clinical Improvement ◽

Calcaneal Malunion ◽

A Prospective Study

Following nonoperative treatment of calcaneal fractures, some patients may develop a disabling malunion with associated posttraumatic arthritis of the subtalar joint, impingement of the peroneal tendons, and hindfoot malalignment. We present a computed tomography classification system for calcaneal malunions which guides treatment and is of prognostic significance. A prospective study was performed using this classification system on a series of 26 malunions treated over a 45-month period. Three distinct types of malunions were identified: type I, lateral wall exostosis without subtalar arthrosis; type II, lateral wall exostosis with subtalar arthrosis; and type III, lateral wall exostosis, subtalar arthrosis, and a varus malunion. The surgical treatment was determined by a protocol based on the specific type of malunion encountered. Results were evaluated using the Maryland Foot Score. There were 18 excellent, 5 good, and 3 fair results. Although outcomes deteriorated as malunion complexity increased, significant clinical improvement as a result of reconstructive surgery was noted in even the worst types of malunion. This algorithm is consistent, prognostic, and useful for the orthopaedic surgeon presented with a symptomatic calcaneal malunion of one of these types.

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Results of Distal Tibia Extra-Articular Type I & Type II Open Fractures Treated with Primary Ilizarov External Fixator - A Prospective Observational Study

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2019/620 ◽

2019 ◽

Vol 8 (37) ◽

pp. 2856-2860

Author(s):

Debanga Sarmaf Barua ◽

Monoranjan How Bora ◽

Manas Jyoti Das ◽

Sidhartha Bansal

Keyword(s):

Observational Study ◽

External Fixator ◽

Prospective Observational Study ◽

Distal Tibia ◽

Open Fractures ◽

Type I ◽

Type Ii ◽

Ilizarov External Fixator

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Comparative Study of Functional Outcomes between OTA/AO type C, Gustilo type I/II Open Fractures and Closed Fractures of the Distal Humerus Treated by Open Reduction and Internal Fixation.

10.21203/rs.3.rs-783337/v1 ◽

2021 ◽

Author(s):

Chen chen ◽

Dan Xiao ◽

Ting Li ◽

Maoqi Gong ◽

Yejun Zha ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Distal Humerus ◽

Open Fractures ◽

Type I ◽

Dash Score ◽

Fracture Group ◽

Type C ◽

Closed Fractures

Abstract Background: To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation.Methods: We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and comparedResults: A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1±13.6 months. There were no significant differences in the hospitalization time, operation time, intraoperative blood loss, medical costs, range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, or complications between the two groups (P>0.05).Conclusion: OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation.Level of Evidence: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

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Outcome of Open Long Bone Fractures in Dogs Stabilized with Linear External Skeletal Fixator

Indian Journal of Animal Research ◽

10.18805/ijar.b-4262 ◽

2021 ◽

Author(s):

Tejpal Singh ◽

Ashwani Kumar ◽

Rahul Kumar Udehiya ◽

Kirandeep Kaur Gill ◽

Tejinder Singh Rai ◽

...

Keyword(s):

Internal Fixation ◽

Open Fracture ◽

Bone Fractures ◽

Open Fractures ◽

Long Bone ◽

Type I ◽

Group Iii ◽

Long Bone Fractures ◽

Group I ◽

Tract Infections

Background: External skeletal fixator (ESF) has been recommended as biological method to stabilize open fracture as it does not involves the wound site, besides protecting adjacent soft tissue structures. Considering the advantages of ESF, this study was envisaged with an objective to study the outcome of open fractures of radius-ulna and tibia-fibula stabilized with linear ESF in dogs.Methods: This study included 17 dogs suffering from open long bone fractures of radius-ulna and tibia-fibula, divided into three groups; linear ESF type I or II (group I, n=8) and type III (group II, n=3). In group III (n=6), open fractures were initially treated using conservative methods i.e management of open wound till complete healing followed by delayed internal fixation using intramedullary pin or bone plating.Result: Majority of the open fractures of radius-ulna and tibia-fibula were transverse (64.71%), involving distal third diaphysis (47.06%) in heavy weight (54.55%), 1-3 year old (64.71%), non-descript (35.29%), male (88.23%) dogs due to automobile accidents (58.82%). Neutrophilic (81.47±4.45%) leukocytosis (24610±2461.88 per cumm) and elevated levels of alkaline phosphatase and creatine kinase were observed. Staphylococcus spp. was the common isolated bacteria sensitive to Gentamicin, Cefotaxime, Tobramycin, Amikacin and Neomycin. High per cent fractures (83.33%) in group III had acceptable functional outcome as compared to fractures treated with linear ESF (55.55%) in groups I and II. Osteomyelitis due to pin tract infections was the major complication (8/11; 72.7%) recorded in ESF groups (Group I and II) that lead to delayed and/or nonunion. Weight bearing score improved markedly after removal of the ESF frame. In conclusions, immediate fixation of the long bone fracture using linear ESF in the presence of open contaminated / infected wounds leads to unacceptable outcome. Poor animal compliance, pin tract discharge, osteomyelitis, delayed union and nonunion are major complications associated with linear ESF. Conservative management of the open fracture wound using standard treatment for 2-3 weeks till complete wound healing followed by internal fixation with intramedullary pin or bone plate is recommended for open long bone fractures in dogs.

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To the question of establishing the severity of bodily injuries in open fractures of the lower limbs

Actual problems of modern medicine ◽

10.26565/2617-409x-2020-6-06 ◽

2020 ◽

Keyword(s):

Retrospective Analysis ◽

Clinical Course ◽

Lower Extremities ◽

Open Fractures ◽

Type I ◽

Articular Fractures ◽

Closed Fractures ◽

Medical Examinations ◽

Fractures Of The Femur ◽

Tubular Bones

Summary: Currently existing "Rules for determining the severity of bodily injuries" do not correspond to the modern classification, the level of knowledge about clinical course and outcomes of open fractures of the lower extremities. Purpose - to conduct a comparative retrospective analysis of forensic medical examinations results to determine the severity of bodily injuries in victims with open and closed fractures of the lower extremities. Material and methods. Research material - 425 acts (170 primary, 185 commissions, 70 complex) forensic medical examinations of victims with fractures of the femur and / or tibia, performed in the Kharkiv Regional Bureau of Forensic Medicine for the period February - June 2018. Research methods - retrospective analysis, descriptive statistics. Results. It was found that both at the time of injury and in the event of its (injury) consequences in victims with a leading injury of the lower extremities, open fractures of the femur and tibia are assessed as severe bodily injuries without taking into account the nature of the fracture and the degree of damage to soft tissues (according to generally accepted classifications), although these data determine the features of treatment measures and the prognosis of trauma at the prehospital and hospital stages. Conclusions. Open fractures of long bones of the lower extremities of type I and II in clinical course, treatment approaches, a risk of complications differ significantly from open fractures of type III. Acute blood loss and hemorrhagic shock, which develop in fractures of long tubular bones as a result of damage of intraosseous, periosteal and muscle vessels, are characteristic of both open and closed fractures. The complicated consequences of open fractures of the lower extremities described in the literature are not life-threatening. The severe bodily injuries revealed as a result of this study were mainly the result of non-union periarticular and intra-articular fractures with persistent joint contracture. The above facts indicate the need to correct the "Rules for determining the severity of injuries" in the case of open fractures of long tubular bones and their differentiated use in fractures of varying complexity with varying degrees of soft tissue damage.

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Evaluation of Ilizarov technique in the treatment of open fractures of tibia

International Surgery Journal ◽

10.18203/2349-2902.isj20204657 ◽

2020 ◽

Vol 7 (11) ◽

pp. 3570

Author(s):

Debdulal Debnath ◽

Jihadul Islam ◽

Nazmul Huda ◽

M. A. A. Shameem

Keyword(s):

Operation Time ◽

Sports Injury ◽

Deep Infection ◽

Open Fractures ◽

Type I ◽

Ilizarov Technique ◽

Duration Of Treatment ◽

Non Union ◽

Medical College ◽

Short Time

Background: Now a day, open fracture of tibia is a common occurrence in the orthopedic treatment arena. Fundamentally, open fractures of tibia are classified into type I, II, IIIA, IIIB and IIIC. The aim of this study was to evaluate the Ilizarov technique in the treatment of open fractures of tibia.Methods: This was an observational prospective study conducted in the Department of Orthopedic Surgery, Northern International Medical College& Hospital, Dhaka, Bangladesh during the period from January 2017 to December 2017. Thirty-six (36) patients with tibial fractures were selected as the study population. This study was approved by the ethical committee of the respective medical college.Results: Out of total 36 participants, 65% were males and 35% were female. In analyzing mode of injuries, we found the highest 80.56% participants were from road accidents followed by 11.11% from sports injury and rest only 8.33% from general falls. The duration of treatment with the fixator was 12-23 weeks (average 16 weeks). In our study total 36 cases were debrided on the same day and stabilized with Ilizarov ring faxator after a period of 5 to 12 days from the date of injury. The operation time ranged from 90 minutes to 120 minutes (Mean 102±4 minutes). Conclusions: In this study no case developed deep infection, non-union or unacceptable mal-union. The construct through Ilizarov is stable and enables the patient to bear weight on the affected limb a short time after the surgery, even in cases of comminuted fractures.

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