Outcomes and Complications With Treatment of Open Tibial Plafond Fractures With Circular External Fixator

Background: Open tibial plafond fractures (Orthopaedic Trauma Association and AO Foundation [OTA/AO] 43) are associated with severe complications, including deep infection (closed fractures, 20%; open fractures, 30%), amputation (3%-14%), and nonunion (up to 25%). Circular external fixators (CEFs) can minimize soft tissue injury. This study aimed to report the rate of union and occurrence of severe complications in patients with open tibial plafond fractures treated with CEFs. Methods: A retrospective review of case series was conducted at 3 level I trauma centers. The study included patients older than 18 years with open tibial plafond fractures treated with CEFs. The reported outcomes included union rate, deep infection, operative complications, and limb alignment. The radiographic measurements of anatomic alignment were obtained. Fifty-two patients were included in the study. Results: The primary union rate was 79%. No deep infection occurred in the majority (92%) of patients. No patient required amputation of the affected limb or free flap coverage. Conclusion: Definitive fixation of open tibial plafond fractures with CEFs avoided severe soft tissue complications but resulted in variation in final radiographic alignment. Level of Evidence: Level IV, case series.

Download Full-text

Intra- and interobserver agreement on the Oestern and Tscherne classification of soft tissue injury in periarticular lower-limb closed fractures

Colombia Medica ◽

10.25100/cm.v45i4.1476 ◽

2014 ◽

pp. 173-178 ◽

Cited By ~ 9

Author(s):

Carlos Oliver Valderrama-Molina ◽

Mauricio Estrada-Castrillón ◽

Jorge Andres Hincapie ◽

Luz Helena Lugo-Agudelo

Keyword(s):

Soft Tissue ◽

Tibial Plateau ◽

Interobserver Agreement ◽

Soft Tissues ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Case Series ◽

Lower Extremities ◽

Tibial Pilon ◽

Pilon Fractures

Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objetive: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions:Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies. Level of Evidence: Level IV, Case Series

Download Full-text

Definitive reconstruction of complex maxillofacial trauma with wide-spread soft-tissue defects: A case series

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2021.69.16 ◽

2021 ◽

Author(s):

Hong Loi Nguyen

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Case Series ◽

Maxillofacial Trauma ◽

Soft Tissue Defects ◽

Wide Spread ◽

Severe Injuries ◽

Tissue Defects

The mаnаgement of soft tissue injury аfter complex fаciаl trаumа poses unique chаllenges to the plаstic surgeon, given the speciаlized nаture of fаciаl tissue аnd the аesthetic importаnce of the fаce. We report 8 cаses with wide-spreаd soft-tissue defects due to complex fаciаl trаumаwho presented аt Odontostomаtology center - Hue centrаl hospitаl during the yeаr 2018.Of these cаses were surgicаlly mаnаged by fixаtion аnd fаciаl reconstructionаt Odonto-stomаtology center - Hue centrаl hospitаl;аnd they were very well recovery in function аnd аesthetics. The generаl principles of trаumа mаnаgement аnd wound cаre аre аpplied in аll cаses. The mаnаgement of severe injuries to the fаce is discussed in relаtion to the locаtion аnd the mechаnism of injury.

Download Full-text

Role of Reamed and Unreamed Interlocking Intermedullary Nailing in the Management of Compound Fracture of Shaft Tibia

Journal of Medical Science & Research ◽

10.47648/jmsr.2014.v2302.04 ◽

2014 ◽

Vol 23 (Number 2) ◽

pp. 21-26

Author(s):

Md. F Ahmed ◽

Md. M Rahman ◽

K Dipu ◽

Md. N Islam

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Deep Infection ◽

Medullary Canal ◽

Open Fractures ◽

Soft Tissue Coverage ◽

Non Union ◽

Interlocking Nailing ◽

Open Injury

Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. The study was done to compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

Download Full-text