Fibula Nail Outcomes in Soft Tissue Compromised Ankle Fractures

2021 ◽  
pp. 107110072110614
Author(s):  
Maryam Ahmed ◽  
Andrew Barrie ◽  
Arun Kozhikunnath ◽  
Abilash Thimmegowda ◽  
Sebastian Ho ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Major Trauma ◽  
Skin Condition ◽  
Fracture Pattern ◽  
Lower Limb Fractures ◽  
Average Body Mass ◽  
Removal Of Hardware ◽  
Limb Fractures ◽  
Safe Approach ◽  
Average Body

Background: To determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. Methods: Retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020. Outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. Results: Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). Conclusion: This multicenter study demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern.

scholarly journals Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? a study from a major trauma centre in England

2021 ◽  
Author(s):  
Rajan Choudhary ◽  
Madhumita Gupta ◽  
Shahidul Haq ◽  
Wareth Maamoun
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Major Trauma ◽  
Trauma Centre ◽  
Open Fractures ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Notable Increase ◽  
Definitive Surgery ◽  
Limb Fractures

<p class="abstract"><strong>Background: </strong>Coronavirus disease 2019 (COVID 19) has created an immense strain on the NHS. During the height of the pandemic, trauma services were affected by redeployment, reduced theatre capacity and staff illness, and COVID BOAST guidelines were introduced.</p><p class="abstract"><strong>Methods: </strong>This retrospective study aimed to evaluate the standards of management of open fractures of the lower limb at a Major Trauma Centre in the United Kingdom during the COVID-19 pandemic and compare the same with the pre-pandemic period. Patient demographics, mechanism of injury, timing and mechanism of initial debridement and definitive soft tissue and skeletal fixation were noted. Outcomes including duration of hospital stay, 30 day and 1 year mortality were also assessed.</p><p class="abstract"><strong>Results: </strong>There was an overall 21% reduction in admissions with open lower limb fractures during the pandemic period with a 48% reduction during the first lockdown. There was a significant reduction in time taken from Emergency Department presentation to first debridement as well as a notable increase in operating outside of regular theatre hours. There was little difference in operative technique used for skeletal or soft tissue management at initial and definitive surgery, though fewer cases were performed as a two stage procedure. There was no difference in amputation rate in the two years. Length of stay was reduced from 21 days to 17, and 30 day mortality remained the same.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows this Major Trauma Centre was able to provide a trauma service in accordance to the BOAST4 guidelines despite the increased pressures of the COVID-19 pandemic.</p>

scholarly journals University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities

2017 ◽  
Vol 73 (1) ◽  
Author(s):  
Mokgobadibe V. Ntsiea ◽  
Witness Mudzi ◽  
Nicolette Comley-White ◽  
Heleen Van Aswegen ◽  
Benita Olivier ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Soft Tissue Injuries ◽  
Health Facilities ◽  
Medical Conditions ◽  
State Health ◽  
Icu Patients ◽  
Lower Limb Fractures ◽  
Tissue Injuries ◽  
Limb Fractures

Background: The healthcare sector requires graduates with the ability to confidently assess and manage the majority of the medical conditions seen in hospitals.Objective: To establish whether the most prevalent medical conditions treated by physiotherapists in Gauteng (South Africa) state health facilities align with the University of the Witwatersrand (Wits) physiotherapy curriculum.Methods: This was a retrospective review of condition-related statistics from physiotherapy departments within the Gauteng province state health facilities. Data from all Gauteng government hospitals that had submitted at least 75% of their physiotherapy condition–related statistics to the provincial statistics coordinator from January 2012 to December 2014 were considered and compared to medical conditions covered in the Wits 2015 physiotherapy curriculum to check if all conditions listed in the Gauteng statistics appeared within the Wits curriculum document. The number of teaching hours for the common conditions was noted to check the emphasis given to these conditions in the curriculum.Results: Eighty-three per cent of the hospitals submitted 75% of their monthly statistics. Overall, the most common conditions treated were lower limb fractures (13%) followed by stroke (7.6%) (n = 705 597). Within the neuro-musculoskeletal category, the most common conditions after lower limb fractures were soft tissue injuries (15.1%) (n = 330 511). The most common cardiopulmonary conditions were tuberculosis (24.9%), followed by pneumonia (13.8%) (n = 94 895). The most common neurological conditions were stroke (30.9%) followed by cerebral palsy (17%) (n = 174 024). Within the non-specified categories, the number of intensive care unit (ICU) patients was the highest (23%), followed by sputum induction (21%) (n = 138 187). The most common conditions that were emphasised within the Wits curriculum as indicated by the teaching hours: fractures, 14.5 (66%) of 22 third-year orthopaedics hours; stroke, 30 (73%) of 41 third-year neurology hours; soft tissue injuries, 18 (38%) of 48 fourth-year neuro-musculoskeletal hours; back lesions, 24 (50%) of 48 fourth-year neuro-musculoskeletal hours; and ICU patients, 30 (79%) of 38 fourth-year cardiopulmonary hours.Conclusion: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.

scholarly journals The impact of a dedicated orthoplastic operating list on time to soft tissue coverage of open lower limb fractures

2015 ◽  
Vol 97 (6) ◽  
pp. 456-459 ◽  
Author(s):  
MA Fernandez ◽  
K Wallis ◽  
M Venus ◽  
J Skillman ◽  
J Young ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Soft Tissue Coverage ◽  
National Guidelines ◽  
Management Standards ◽  
Lower Limb Fractures ◽  
Time Period ◽  
Operating List ◽  
Limb Fractures ◽  
The Impact

An observational study was conducted of 105 patients presenting with an open fracture of the tibia or ankle to determine the impact of a dedicated orthoplastic operating list on our management of these injuries over the time period January 2012 to July 2014. There were 51 patients before and 54 after the introduction of the orthoplastic list. Significant improvements were noted in our ability to deliver a service in line with national guidelines across all Gustilo–Anderson grades of injury. Among patients with the most severe grades of injury (Gustilo types IIIB and IIIC), there was a trend towards an improved time to first skeletal stabilisation (29.5 vs 14.2 hours, p=0.068), an improvement in time to soft tissue coverage (173.6 vs 88.1 hours, p=0.009) and a trend towards a reduced length of inpatient stay (32.6 vs 23.2 days, p=0.138). Where the 72-hour target had been breached, there was a significant improvement in the proportion of patients covered within 7 days of injury (48.2% vs 83.3%, p=0.017). Our compliance with national management standards increased significantly to reflect these improvements in care. These results support the implementation of dedicated orthoplastic operating sessions to meet the growing burden of patients presenting with open fractures at specialist centres.

Open lower limb fractures in Major Trauma Centers – A loss leader?

Injury ◽  
2017 ◽  
Vol 48 (2) ◽  
pp. 353-356 ◽  
Author(s):  
Elizabeth K. Tissingh ◽  
Arman Memarzadeh ◽  
Joseph Queally ◽  
Peter Hull
Keyword(s):  
Lower Limb ◽  
Major Trauma ◽  
Trauma Centers ◽  
Lower Limb Fractures ◽  
Loss Leader ◽  
Limb Fractures

scholarly journals Update on the Management of Open Lower Limb Fractures

2012 ◽  
Vol 6 (1) ◽  
pp. 571-577 ◽  
Author(s):  
M Griffin ◽  
M Malahias ◽  
W Khan ◽  
S Hindocha
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Team Work ◽  
Current Evidence ◽  
Optimal Time ◽  
Soft Tissue Coverage ◽  
Current Recommendation ◽  
Lower Limb Fractures ◽  
Vascular Compromise ◽  
Limb Fractures

Open lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone loss and potential vascular compromise. These fracture require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties to ensure good clinical outcomes. Extensive research has improved the outcomes of open lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of open tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, providing antibiotics and soft tissue coverage will be outlined as well as the indications for amputation.

scholarly journals Update on the Management of Compound Lower Limb Fractures

2012 ◽  
Vol 6 (1) ◽  
pp. 518-524 ◽  
Author(s):  
M Griffin ◽  
M Malahias ◽  
S Hindocha ◽  
W Khan
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Team Work ◽  
Current Evidence ◽  
Optimal Time ◽  
Soft Tissue Coverage ◽  
Current Recommendation ◽  
Lower Limb Fractures ◽  
Bone Injury ◽  
Limb Fractures

Compound lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone injury and potential vascular compromise. These fractures require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties, to ensure good clinical outcomes. Extensive research has improved the outcomes of compound lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of compound tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, antibiotic regime and soft tissue coverage will be outlined as well as the indications for amputation.

scholarly journals Cycling-related orthopaedic fractures admitted to the Major Trauma Centre in the cycling capital of the UK

2021 ◽  
Author(s):  
Omar Jamil ◽  
Sofyan Al Shdefat ◽  
Zaki Arshad ◽  
Azeem Thahir ◽  
Fahim Anwar ◽  
...  
Keyword(s):  
United Kingdom ◽  
Major Trauma ◽  
Trauma Centre ◽  
Appendicular Skeleton ◽  
The United Kingdom ◽  
Lower Limb Fractures ◽  
Major Trauma Centre ◽  
Safety Interventions ◽  
The Uk ◽  
Limb Fractures

Abstract Introduction The popularity of cycling in the United Kingdom is increasing, with a further rise likely due to recent government cycling promotion schemes. This study aims to characterise fractures sustained due to cycling-related collisions in patients presenting to a Major Trauma Centre, in the region with the highest cycling rates in the United Kingdom. Methods A retrospective analysis of cycling injuries presenting to our centre between January 2012 and December 2020 was performed using a prospectively collected electronic database. Comparison of fracture characteristics was made according to patient age and mechanism of injury (collision with a motorised vehicle versus collision with a non-motorised object.). Results Of the 737 patients who suffered a cycling-related injury, 292 (39.6%) suffered at least 1 fracture to the appendicular skeleton. Overall, fractures were most commonly seen in those over 50 years of age. Upper limb fractures were more common than lower limb fractures. Fractures sustained during motorised injuries were more likely to require surgical intervention than those sustained during non-motorised collisions. Conclusion This study provides valuable information regarding the nature, epidemiology and treatment of fractures sustained following cycling-related accidents, adding to the paucity of similar literature in the field. Given the likely increase in future cycling uptake, our results are important to clinicians treating patients with cycling-related injuries and policymakers designing safety interventions.

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