Soft Tissue Coverage and Outcome of Gustilo Grade IIIB Mid-Shaft Tibial Fractures: A 15-Year Experience

Background: The fractures of distal tibia including tibial pilon pose a great challenge to the surgeon due to subcutaneous location, scarcity of blood supply and paucity of soft tissue coverage. Minimal invasive plating osteosynthesis (MIPO) has evolved as a newer concept to treat distal tibial fractures with minimal articular comminution and minimal soft tissue damage. Aim of the present study was to evaluate the results of MIPO technique with use of a locking plate in fracture tibia distal end. Method: During the study period of two years, total 45 cases of closed distal tibial fractures (Diaphyseal and metaphyseal region) were operated by MIPO technique with a distal tibial anatomical locking plate (3.5 and 4.5 mm). They were followed up at regular intervals and results were evaluated. Results: The age of the patients ranged from 20-60 years with the majority (19; 42.22%) of them being in the age of 40-50 years. The most common mode of injury was road traffic accident (33; 73.33%). In all patients MIPO was performed, in none of them, fracture site was opened. Mobilization of adjacent joints was carried out mostly from second to fourth postoperative day. Most of the fractures united between 10-12 weeks (26; 57.77%). On analyzing the results of MIPO, excellent results were seen in 66.66% cases and 33.34% had satisfactory results. Conclusion: Hereby we concluded that though various modalities of treatment of fractures of the distal tibia are present MIPO seem to be better technique if done under skillful guidance as done in this study.

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Predicting the Outcome of Open Type IIIC Tibial Fractures Regarding Union, Osteomyelitis, and Amputation

10.21203/rs.3.rs-1141622/v1 ◽

2021 ◽

Author(s):

Shih-Heng Chen ◽

Po-Hao Lien ◽

Ching-Yu Lan ◽

Chung-Cheng Hsu ◽

Cheng-Hung Lin ◽

...

Keyword(s):

Soft Tissue ◽

Multiple Trauma ◽

Injury Severity ◽

Significant Risk ◽

Arterial Injury ◽

Delayed Union ◽

Tibial Fractures ◽

Soft Tissue Coverage ◽

Predicted Probability ◽

Tibia Fractures

Abstract Backgrounds: This study aimed to assess factors that affect union time and complications in Gustilo IIIC tibial fractures.Methods: Patients who presented to our center with IIIC open tibial fractures from January 2000 to October 2020 were eligible for this retrospective analysis. Patient demographics, fracture characteristics, timing, numbers, and type of surgical intervention were documented. Outcomes of interest included union time, occurrence of osteomyelitis, and amputation. Results: Fifty-eight patients were enrolled and grouped by fracture type; eight union on time (13.8%); 27 late union (46.6%); eight delayed union (13.8%); three nonunion (5.2%); and 12 amputation (20.7%). Nine fractures (15.5%) were complicated by osteomyelitis. Union time was prolonged in cases of triple arterial injury, distal third fractures, multiple trauma with Injury Severity Score (ISS) ≥ 16 points, and increased length of bone defect. Additionally, a bone gap > 50 mm, diabetes mellitus, low body mass index, and triple arterial injury in the lower leg were significant risk factors for amputation. A time from injury to definitive soft tissue coverage of more than 22 days was the major risk factor for osteomyelitis. A scoring system to predict union time was devised and the predicted probability of union within two years was stratified based on this score. Conclusions: IIIC tibial fractures involving the distal third of the tibia, fractures with bone defects, triple arterial injury, and multiple trauma with ISS ≥ 16 points demonstrated delayed union, and an effective prediction system for union time was introduced in this study. Early soft tissue coverage can reduce the risk of osteomyelitis. Finally, diabetes and severe bone and soft tissue defects pose a higher risk of amputation.

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A PROSPECTIVE STUDY OF EARLY SOFT TISSUE COVERAGE OF GRADE IIIB TIBIAL FRACTURES

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199405000-00011 ◽

1994 ◽

Vol 36 (5) ◽

pp. 661-668 ◽

Cited By ~ 31

Author(s):

Philip P. Trabulsy ◽

Suzanne M. Kerley ◽

William Y. Hoffman

Keyword(s):

Soft Tissue ◽

Prospective Study ◽

Tibial Fractures ◽

Soft Tissue Coverage ◽

A Prospective Study

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Functional Outcome of Open Tibial Fracture Using Illizarov Apparatus

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i41a32302 ◽

2021 ◽

pp. 62-65

Author(s):

Abhishek Choukse

Keyword(s):

Soft Tissue ◽

Functional Outcome ◽

Tibial Fracture ◽

Tibial Fractures ◽

Wound Complications ◽

Soft Tissue Coverage ◽

Hybrid Technique ◽

Open Tibial Fracture ◽

Ring Fixator ◽

Ilizarov Ring Fixator

The better treatment for tibial fractures are very vague and difficult. Since the tibia is covered by soft tissue coverage fixing of plate becomes very difficult as it creates wound complications, mainly in case of severe fractures.In this study of 20 cases of open communited fractures of tibia with the Ilizarov ring fixator hybrid technique was used, it was found that this technique has a major advantages in treatment and management of the tibial fracture.

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Management of Gustilo–Anderson IIIB open tibial fractures in adults—a systematic review

British Medical Bulletin ◽

10.1093/bmb/ldab013 ◽

2021 ◽

Author(s):

A Myatt ◽

H Saleeb ◽

G A J Robertson ◽

Jana Keren Bourhill ◽

P R J Page ◽

...

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Pragmatic Trial ◽

Deep Infection ◽

Tibial Fractures ◽

High Rate ◽

Long Bone ◽

Soft Tissue Coverage ◽

Muscle Flaps ◽

Open Tibial Fractures

Abstract Introduction Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons. Sources of data We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures. Areas of agreement and controversy Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. Growing points It is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage. Areas timely for developing research A national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes.

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Versatility of the Posterior Interosseous Artery Flap: Emphasis on Powering Up the Toe Transfer

Hand ◽

10.1177/15589447211028925 ◽

2021 ◽

pp. 155894472110289

Author(s):

GiJun Lee ◽

BumSik Kim ◽

Neunghan Jeon ◽

JungSoo Yoon ◽

Ki Yong Hong ◽

...

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Reverse Flow ◽

Donor Site ◽

Congenital Defects ◽

Soft Tissue Coverage ◽

Posterior Interosseous Artery ◽

Arterial Inflow ◽

Pedicle Length ◽

Interosseous Artery

Background: Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. Materials and Methods: Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. Results: This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. Conclusion: The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

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