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

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.

scholarly journals The Classification of Long Bone Osteomyelitis: A Systemic Review of the Literature

2017 ◽  
Vol 2 (4) ◽  
pp. 167-174 ◽  
Author(s):  
Andrew J. Hotchen ◽  
Martin A. McNally ◽  
Parham Sendi
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Classification System ◽  
Classification Systems ◽  
Bone Involvement ◽  
Long Bone ◽  
Soft Tissue Coverage ◽  
Host Status ◽  
Long Bone Osteomyelitis

Abstract. Background: Osteomyelitis is a complex disease. Treatment involves a combination of bone resection, antimicrobials and soft-tissue coverage. There is a difficulty in unifying a classification system for long bone osteomyelitis that is generally accepted.Objectives: In this systematic review, we aim to investigate the classification systems for long bone osteomyelitis that have been presented within the literature. By doing this, we hope to elucidate the important variables that are required when classifying osteomyelitis.Methods: A complete search of the Medline, EMBASE, Cochrane and Ovid databases was undertaken. Following exclusion criteria, 13 classification systems for long-bone osteomyelitis were included for review.Results: The 13 classification systems that were included for review presented seven different variables that were used for classification. Ten of them used only one main variable, two used two variables and one used seven variables. The variables included bone involvement (used in 7 classification systems), acute versus chronic infection (used in 6), aetiopathogenesis (used in 3), host status (used in 3), soft tissue (used in 2), microbiology (used in 1) and location of infected bone (used in 1). The purpose of each classification system could be grouped as either descriptive (3 classification systems), prognostic (4) or for management (4). Two of the 13 classification systems were for both prognostic and management purposes.Conclusions: This systematic review has demonstrated a variety of variables used for classification of long bone osteomyelitis. While some variables are used to guide management and rehabilitation after surgery (e.g., bone defect, soft tissue coverage), others were postulated to provide prognostic information (e.g., host status). Finally, some variables were used for descriptive purposes only (aetiopathogenesis). In our view and from today's perspective, bone involvement, antimicrobial resistance patterns of causative micro-organisms, the need for soft-tissue coverage and host status are important variables to include in a classification system.

scholarly journals Soft tissue management of children's open tibial fractures – a review of seventy children over twenty years

2010 ◽  
Vol 92 (4) ◽  
pp. 320-325 ◽  
Author(s):  
P Rao ◽  
MV Schaverien ◽  
KJ Stewart
Keyword(s):  
Soft Tissue ◽  
Tibial Fractures ◽  
Soft Tissue Management ◽  
Retrospective Case ◽  
Open Tibial Fractures ◽  
Fractures In Children ◽  
Superficial Wound ◽  
Patient Stay ◽  
Grade Ii ◽  
Distally Based

INTRODUCTION The management of open tibial fractures in children represents a unique reconstructive challenge. The aim of the study was to evaluate the management of paediatric open tibial fractures with particular regard to soft tissue management. PATIENTS AND METHODS A retrospective case-note analysis was performed for all children presenting with an open tibial fracture at a single institution over a 20-year period for 1985 to 2005. RESULTS Seventy children were reviewed of whom 41 were males and 29 females. Overall, 91% (n = 64) of children suffered their injury as a result of a vehicle-related injury. The severity of the fracture with respect to the Gustilo classification was: Grade I, 42% (n = 29); Grade II, 24% (n = 17); Grade III, 34% (n = 24; 7 Grade 3a, 16 Grade 3b, 1 Grade 3c). The majority of children were treated with external fixation and conservative measures, with a mean hospital in-patient stay of 13.3 days. Soft tissue cover was provided by plastic surgeons in 31% of all cases. Four cases of superficial wound infection occurred (6%), one case of osteomyelitis and one case of flap failure. The limb salvage was greater than 98%. CONCLUSIONS In this series, complications were associated with delayed involvement of plastic surgeons. Retrospective analysis has shown a decreased incidence of open tibial fractures which is reported in similar studies. Gustilo grade was found to correlate with length of hospital admission and plastic surgery intervention. We advocate, when feasible, the use of local fas-ciocutaneous flaps (such as distally based fasciocutaneous and adipofascial flaps), which showed a low complication rate in children.

Negative Pressure Wound Therapy Reduces Deep Infection Rate in Open Tibial Fractures

2012 ◽  
Vol 26 (9) ◽  
pp. 499-505 ◽  
Author(s):  
Martin L. Blum ◽  
Max Esser ◽  
Martin Richardson ◽  
Eldho Paul ◽  
Franklin L. Rosenfeldt
Keyword(s):  
Infection Rate ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Deep Infection ◽  
Tibial Fractures ◽  
Wound Therapy ◽  
Open Tibial Fractures

scholarly journals Microsurgical Reconstruction of the Lower Extremity

2019 ◽  
Vol 33 (01) ◽  
pp. 054-058 ◽  
Author(s):  
Luke Grome ◽  
William Pederson
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Donor Site ◽  
Foot Drop ◽  
Long Term Results ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Muscle Flaps ◽  
Microsurgical Reconstruction

AbstractReconstruction of bony and soft tissue defects of the lower extremity has been revolutionized by the advent of microsurgical tissue transfer. There are numerous options for reconstruction. Possibilities include transfer of soft tissue, composite (bone and soft tissue) tissue, and functional muscle. Many lower extremity reconstructions require staged procedures. Planning is of paramount importance especially in regard to vascular access when multiple free flaps are required. Soft tissue reconstruction of the lower extremity may be accomplished with muscle flaps such as the rectus femoris and latissimus dorsi covered with a skin graft. Fasciocutaneous flaps such as the anterolateral thigh flap may be more appropriate in a staged reconstruction which requires later elevation of the flap. Loss of a significant portion of bone, such as the tibia, can be difficult to manage. Any gap greater than 6 cm is considered a reasonable indication for vascularized bone transfer. The contralateral free fibula is the donor site of choice. Functional reconstruction of the anterior compartment of the leg may be performed with a gracilis muscle transfer, effectively eliminating foot drop and providing soft tissue coverage. Muscle tensioning is critical for effective excursion and dorsiflexion of the foot. Long-term results of microsurgical reconstruction of the lower extremity show good results and reasonable rates of limb salvage.

scholarly journals Immediate Interlocking Nailing versus External Fixation Followed by Delayed Interlocking Nailing for Gustilo Type IIIB Open Tibial Fractures

2007 ◽  
Vol 15 (2) ◽  
pp. 131-136 ◽  
Author(s):  
HJ Park ◽  
M Uchino ◽  
K Nakamura ◽  
M Ueno ◽  
Y Kojima ◽  
...  
Keyword(s):  
Standard Deviation ◽  
External Fixation ◽  
Deep Infection ◽  
Fracture Site ◽  
Tibial Fractures ◽  
Fracture Type ◽  
Infection Rates ◽  
Open Tibial Fractures ◽  
Interlocking Nailing ◽  
Type Iiib

Purpose. To compare immediate interlocking nailing with external fixation followed by delayed interlocking nailing, for Gustilo type IIIB open tibial fractures. Methods. 23 patients with Gustilo IIIB open tibial fractures were treated with either immediate unreamed interlocking nailing (n=9) or external fixation followed by delayed unreamed interlocking nailing (n=14). Patient age, sex ratio, fracture site, fracture type, and severity were similar in both groups. The time to union, deep infection rate, and nonunion rate in the 2 groups were compared. Results. In the immediate and delayed nailing groups, respective mean times to union were 21 (standard deviation [SD], 14) months and 14 (SD, 8) months; nonunion rates were 44% (4/9) and 36% (5/14), and deep infection rates were 22% (2/9) and 7% (1/14). All corresponding differences were not statistically significant. Conclusion. Prospective, randomised, multicentre studies are needed to assess whether there are significant differences between the 2 treatment methods.

scholarly journals The role of plating in the operative treatment of severe open tibial fractures: a systematic review

2007 ◽  
Vol 33 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Peter V. Giannoudis ◽  
Costas Papakostidis ◽  
George Kouvidis ◽  
Nikolaos K. Kanakaris
Keyword(s):  
Systematic Review ◽  
Operative Treatment ◽  
Tibial Fractures ◽  
Open Tibial Fractures
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