Orthoplastic management of open tibial fractures in children

2021 ◽  
Vol 103-B (6) ◽  
pp. 1160-1167
Author(s):  
James Richard Alexander Smith ◽  
Clare E. Fox ◽  
Thomas C. Wright ◽  
Umraz Khan ◽  
Anna M. Clarke ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Free Flaps ◽  
Deep Infection ◽  
Tibial Fractures ◽  
Consecutive Series ◽  
Open Tibial Fractures ◽  
Vehicle Collision ◽  
Fractures In Children ◽  
Patient Reported ◽  
Superficial Wound

Aims Open tibial fractures are limb-threatening injuries. While limb loss is rare in children, deep infection and nonunion rates of up to 15% and 8% are reported, respectively. We manage these injuries in a similar manner to those in adults, with a combined orthoplastic approach, often involving the use of vascularised free flaps. We report the orthopaedic and plastic surgical outcomes of a consecutive series of patients over a five-year period, which includes the largest cohort of free flaps for trauma in children to date. Methods Data were extracted from medical records and databases for patients with an open tibial fracture aged < 16 years who presented between 1 May 2014 and 30 April 2019. Patients who were transferred from elsewhere were excluded, yielding 44 open fractures in 43 patients, with a minimum follow-up of one year. Management was reviewed from the time of injury to discharge. Primary outcome measures were the rate of deep infection, time to union, and the Modified Enneking score. Results The mean age of the patients was 9.9 years (2.8 to 15.8), and 28 were male (64%). A total of 30 fractures (68%) involved a motor vehicle collision, and 34 (77%) were classified as Gustilo Anderson (GA) grade 3B. There were 17 (50%) GA grade 3B fractures, which were treated with a definitive hexapod fixator, and 33 fractures (75%) were treated with a free flap, of which 30 (91%) were scapular/parascapular or anterolateral thigh (ALT) flaps. All fractures united at a median of 12.3 weeks (interquartile range (IQR) 9.6 to 18.1), with increasing age being significantly associated with a longer time to union (p = 0.005). There were no deep infections, one superficial wound infection, and the use of 20 fixators (20%) was associated with a pin site infection. The median Enneking score was 90% (IQR 87.5% to 95%). Three patients had a bony complication requiring further surgery. There were no flap failures, and eight patients underwent further plastic surgery. Conclusion The timely and comprehensive orthoplastic care of open tibial fractures in this series of patiemts aged < 16 years resulted in 100% union and 0% deep infection, with excellent patient-reported functional outcomes. Cite this article: Bone Joint J 2021;103-B(6):1160–1167.

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

Type III open tibial fractures in children

2001 ◽  
Vol 11 (3) ◽  
pp. 169-175 ◽  
Author(s):  
M. Fujita ◽  
K. Yokoyama ◽  
T. Tsukamoto ◽  
S. Aoki ◽  
T. Noumi ◽  
...  
Keyword(s):  
Tibial Fractures ◽  
Open Tibial Fractures ◽  
Type Iii ◽  
Fractures In Children

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.

Reamed Nailing of Open Tibial Fractures: Does the Antibiotic Bead Pouch Reduce the Deep Infection Rate?

1996 ◽  
Vol 10 (5) ◽  
pp. 298-303 ◽  
Author(s):  
J. F. Keating ◽  
P. A. Blachut ◽  
P. J. O'Brien ◽  
R. N. Meek ◽  
H. Broekhuyse
Keyword(s):  
Infection Rate ◽  
Deep Infection ◽  
Tibial Fractures ◽  
Open Tibial Fractures

Total ankle arthroplasty

2021 ◽  
Vol 103-B (4) ◽  
pp. 696-703
Author(s):  
Timothy M. Clough ◽  
Joseph Ring
Keyword(s):  
Survival Rates ◽  
Patient Reported Outcome Measures ◽  
Deep Infection ◽  
Patient Reported Outcome ◽  
Consecutive Series ◽  
Superficial Infection ◽  
Ankle Arthroplasty ◽  
Joint Registry ◽  
Patient Reported

Aims We report the medium-term outcomes of a consecutive series of 118 Zenith total ankle arthroplasties (TAAs) from a single, non-designer centre. Methods Between December 2010 and May 2016, 118 consecutive Zenith prostheses were implanted in 114 patients. Demographic, clinical, and patient-reported outcome measures (PROMs) data were collected. The endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals (CIs) and the rate of failure calculated for each year. Results Eight patients (ten ankles) died during follow-up, but none required revision. Of the surviving 106 patients (108 ankles: rheumatoid arthritis (RA), n = 15; osteoarthritis (OA), n = 93), 38 were women and 68 were men, with a mean age of 68.2 years (48 to 86) at the time of surgery. Mean follow-up was 5.1 years (2.1 to 9.0). A total of ten implants failed (8.5%), thus requiring revision. The implant survival at seven years, using revision as an endpoint, was 88.2% (95% CI 100% to 72.9%). There was a mean improvement in Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) from 85.0 to 32.8 and visual analogue scale (VAS) scores from 7.0 to 3.2, and overall satisfaction was 89%. The three commonest complications were malleolar fracture (14.4%, n = 17), wound healing (13.6%, n = 16), and superficial infection (12.7%, n = 15). The commonest reason for revision was aseptic loosening. No patients in our study were revised for deep infection. Conclusion Our results show that Zenith survival rates are comparable with those in the literature for other implants and in the National Joint Registry (NJR). Overall patient satisfaction was high as were functional outcomes. However, the data highlight potential complications associated with this surgery. The authors believe that these figures support ankle arthroplasty as an option in the treatment of ankle arthritis. Cite this article: Bone Joint J 2021;103-B(4):696–703.

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