Bilateral Gastrocnemius Flap For Harlequin Defects Around The Knee

Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 were included in this study. The mean age was 38 years (range 18–50 years) and the mean duration of follow-up was 10 months. Outcome assessments included the condition of the flap and fracture healing time. Result : All fractures united after surgery. There were no soft tissue complications and all flaps healed well. The mean bony union time was 6 months. Conclusion: Our technique of covering soft tissue loss at surgical site on medial and lateral side of proximal tibia with bilateral gastrocnemius flap in the same setting is a reliable and safe surgical method for these conditions.

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Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

10.21203/rs.3.rs-41966/v1 ◽

2020 ◽

Author(s):

Jiazhao Yang ◽

Wanbo Zhu ◽

Qirong Dong

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Study Data ◽

Fracture Site ◽

Tibial Fractures ◽

Early Complications ◽

The Mean ◽

Staged Treatment

Abstract Background and Objective: Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment. However, early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed. This study aimed to analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.Materials and Methods: A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a level-1 trauma center from 2014 to 2018 were enrolled in this retrospective study. Data regarding the demographic information, Tscherne soft tissue injury, fracture site, entry point placement, and duration of traction were recorded. Procedure-related complications such as movement and sensation disorder, vessel injury, discharge, infection, loosening, and iatrogenic fracture were analyzed.Results: The mean patient age was 42.5 (18–71) years and the mean duration of traction was 7.5 (0–26) days. In total, 19 (4.7%) patients presented with procedure-related complications, including technique-associated complications in 6 patients and nursing-associated complications in 13. Differences in the incidence of complications with respect to sex, affected side, soft tissue injury classification, and fracture sites were not observed. However, the number of complications due to hammer insertions was significantly fewer than those due to drill insertions (2.9% vs. 7.4%).Conclusion: The application of preoperative external traction fixation had been proved to be an ideal alternative treatment for high energy tibial fractures. In this study, we found the incidence of early complications of the fixation is low, and it is not significantly associated with the severity of soft tissue injury and fracture site. Although relatively rough and more likely to cause pain, complications of hammer insertions were significantly fewer than drill insertions. The possible reason was higher probability of heat damage and loosening by drilling.

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Acute Compartment Syndrome of Upper Extremities with Tendon Ruptures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500423 ◽

2017 ◽

Vol 22 (04) ◽

pp. 411-415

Author(s):

Taku Suzuki ◽

Eiko Yamabe ◽

Takuji Iwamoto ◽

Katsuji Suzuki ◽

Harumoto Yamada ◽

...

Keyword(s):

Soft Tissue ◽

Compartment Syndrome ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Skin Grafting ◽

High Energy ◽

Acute Compartment Syndrome ◽

Mechanism Of Injury ◽

Sensory Disturbances

Background: It is well known that acute compartment syndrome is associated with fracture of the forearm, while involvement of soft tissue injury including musculotendinous injury remains unclear. The purpose of this study was to evaluate the soft tissue involvement, including musculotendinous ruptures, in acute compartment syndrome of the upper limb. Methods: We retrospectively enrolled 16 patients who underwent surgical treatment for acute compartment syndrome of the upper extremity. The average age of the patients was 47 years (range, 14 to 79) and the mean follow-up period after the surgery was 15 months (range, 12 to 29). Complications included at least one presentation at the final follow up of sensory disturbances or motor disturbances. We examined the presence of musculotendinous injury mechanism of injury, presence of fracture, the performance of skin grafting, and complications. Results: Mechanism of injury of “caught in a machine” was found in six cases. Three of these patients had musculotendinous ruptures and all muscle tears were revealed by intraoperative findings. No patients had muscle ruptures with other injury mechanisms. Seven out of 16 patients (44%) developed complications at final follow-up. Skin grafting was performed in six patients, and five of these patients developed complications. Only one of the nine patients without complications underwent skin grafting. Conclusions: In cases of high-energy injuries, the surgeon should suspect the presence of a musculotendinous injury prior to surgery.

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Percutaneous Posterior to Anterior Screw Fixation of the Talar Neck

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00204 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0020

Author(s):

Cesar de Cesar Netto ◽

Lauren Roberts ◽

Alexandre Godoy Dos Santos ◽

Jackson Staggers ◽

Sung Lee ◽

...

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Injury Rate ◽

Posterolateral Approach ◽

Flexor Hallucis Longus ◽

Peroneal Tendons ◽

The Mean ◽

Tissue Structures

Category: Trauma Introduction/Purpose: Fractures of the talar neck and body can be fixed with percutaneously placed screws directed from anterior to posterior or posterior to anterior. The latter has been found to be biomechanically and anatomically superior. Percutaneous pin and screw placement poses anatomic risks for posterolateral and posteromedial neurovascular and tendinous structures. The objective of this study was to enumerate the number of trials for proper placement of two parallel screws and to determine the injury rate to neurovascular and tendinous structures. Methods: Eleven fresh frozen cadaver limbs were used. 2.0 mm guide wires from the Stryker (Selzach, Switzerland) 5.0-mm headless cannulated set were percutaneously placed (under fluoroscopic guidance) into the distal posterolateral aspect of the ankle. All surgical procedures were performed by a fellowship-trained foot and ankle surgeon. Malpositioned pins were left intact to allow later assessment of soft tissue injury. The number of guide wires needed to achieve an acceptable positioning of the implant was noted. Acceptable positioning was defined as in line with the talar neck axis in both AP and lateral fluoroscopic views. After a layered dissection from the skin to the tibia, we evaluated neurovascular and tendinous injuries, and measured the shortest distance between the closest guide pin and the soft tissue structures, using a precision digital caliper. Results: The mean number of guide wires needed to achieve acceptable positioning for 2 parallel screws was 2.91 ± 0.70 (range, 2 - 5). The mean distances between the closest guide pin and the soft tissue structures of interest were: Achilles tendon, 0.53 ± 0.94 mm; flexor hallucis longus tendon, 6.62 ± 3.24 mm; peroneal tendons, 7.51 ± 2.92 mm; and posteromedial neurovascular bundle, 11.73 ± 3.48 mm. The sural bundle was injured in all the specimens, with 8/11 (72.7%) in direct contact with the guide pin and 3/11 (17.3%) having been transected. The peroneal tendons were transected in 1/11 (9%) of the specimens. The Achilles tendon was in contact with the guide pin in 6/11 (54.5%) specimens and transected in 2/11 (18.2%) specimens. Conclusion: The placement of posterior to anterior percutaneous screws for talar neck fixation is technically demanding and multiple guide pins are needed. Our cadaveric study showed that important tendinous and neurovascular structures are in close proximity with the guide pins and that the sural bundle was injured in 100% of the cases. We advise performing a formal small posterolateral approach for proper visualization and retraction of structures at risk. Regardless, adequate patient education about the high risk of injury from this procedure is crucial.

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Autologous platelets and leukocytes can improve healing of infected high-energy soft tissue injury

Transfusion and Apheresis Science ◽

10.1016/j.transci.2009.05.006 ◽

2009 ◽

Vol 41 (1) ◽

pp. 9-12 ◽

Cited By ~ 46

Author(s):

Agata Cieslik-Bielecka ◽

Tomasz Bielecki ◽

Tadeusz S. Gazdzik ◽

Jerzy Arendt ◽

Wojciech Król ◽

...

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

High Energy

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Staged Subtalar Fusion for Severe Calcaneus Fractures with Bone Loss

The Open Orthopaedics Journal ◽

10.2174/1874325001307010614 ◽

2013 ◽

Vol 7 (1) ◽

pp. 614-618 ◽

Cited By ~ 1

Author(s):

Chad G. Williams ◽

Michael J. Coffey ◽

Peter Shorten ◽

James D. Lyions ◽

Richard T. Laughlin

Keyword(s):

Soft Tissue ◽

Bone Loss ◽

Soft Tissues ◽

Tissue Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Fusion Procedure ◽

Subtalar Fusion ◽

Thorough Debridement ◽

Calcaneus Fractures

Background: With high energy fractures to the calcaneus there is the potential for significant bone loss. The loss of bone can make it difficult to fully regain calcaneal alignment. In addition these fractures are often associated with significant soft tissue injury. These two factors make it difficult to address this injury in a single stage, and can have significant complications. To address these issues our initial goal in treatment has been restoration of calcaneal alignment and stabilization of the surrounding soft tissue, followed by delayed/staged subtalar arthrodesis. Methods: Patients with calcaneus fractures treated by a single surgeon from 2002 to 2012 were reviewed. Injuries which were found to have medial extrusion of the posterior facet and bone loss, and subsequently underwent a staged protocol involving early provisional fixation and late subtalar fusion were included. Results: We treated 6 calcaneus fractures with bone loss. All patients were treated with staged subtalar fusion after initial irrigation and debridement and provisional fixation. No soft-tissue complications were noted after the fusion procedure in any of the six cases. Fusion occurred in all six patients at an average of 20.6 weeks (range, 13-23 weeks). All patients were able to ambulate and wear a regular shoe by one year following the initial injury. Conclusion: It is important in the high energy calcaneus fracture to assess for both soft tissue integrity and bone loss. A thorough debridement of both the soft tissues and any devitalized bone should be performed as well as provisional fixation which attempts to restore near normal calcaneal anatomy. Definitive fusion should not be performed until the soft tissues have fully recovered.

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Result of Ring Fixator in High-energy Schatzker Type VI Fractures of Proximal Tibia

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i43b32574 ◽

2021 ◽

pp. 451-459

Author(s):

Aftab Alam Khanzada ◽

Muhammad Rafique Joyo ◽

Muhammad Imran Javed ◽

Nizam Ahmed ◽

Niaz Hussain Keerio ◽

...

Keyword(s):

Soft Tissue ◽

Tissue Damage ◽

Proximal Tibia ◽

High Energy ◽

Soft Tissue Damage ◽

Soft Tissue Envelope ◽

Ring Fixator ◽

Schatzker Type ◽

Tibia Fractures ◽

Proximal Tibia Fractures

Background: Significant articular depression, separation of both condyles, diaphyseal comminution and dissociation, and loss of soft-tissue envelope integrity are all associated with high-energy proximal tibia fractures (Schatzker VI). Over the past 50 years, there has been a lot of research on plating problems in these complicated fractures. For the care of these complex injuries, Ilizarov devised a new method (ring fixator). Aim of the Study: To examine the outcomes of patients who received a ring fixator for the treatment of high-energy proximal tibia fractures (Schatzker VI). Materials and Methods: Fourteen patients (mean age 36) were treated with the Ilizarov fixator and transfixion wires for high-energy fractures of the proximal tibia (Schatzker VI). Nine of the patients had open fractures, and five of them had significant soft tissue damage. They were all tracked for an average of 19.4 months. The result was analyzed using the criteria set by Honkonen & Jarvinen (1992). Results: Thirteen fractures healed in an average of 14.6 weeks, with one taking six months. Twelve patients recovered complete extension, while eight others regained more than 110 degrees of flexion. All of the patients knees were stable, except one who had a minor varus deformity. Nine patients walked normally, while four had a little limp. Except for one, all of the knees exhibited an articular step-off of less than 4 mm and normal axial alignment. Six knees were found to be outstanding, five to be decent, and three to be fair. There were no instances of postoperative skin infection or septic arthritis, however, three patients did have a pin tract infection that was effectively managed. Conclusion: The technique is suitable for the treatment of complex proximal tibia fractures when there is substantial comminution at the fracture site as well as soft tissue damage (Schatzker VI).

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Induced Hypothermia After High-Energy Soft-Tissue Injury and Subsequent Hemorrhagic Shock

Shock ◽

10.1097/00024382-200202000-00007 ◽

2002 ◽

Vol 17 (2) ◽

pp. 120-126 ◽

Cited By ~ 6

Author(s):

Andreas Wladis ◽

Robert G. Hahn ◽

Bo Brismar ◽

B. Thomas Kjellstr??m

Keyword(s):

Soft Tissue ◽

Hemorrhagic Shock ◽

Tissue Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Induced Hypothermia

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Open Periprosthetic Knee Fracture: A Case Report and Review of the Literature

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320939547 ◽

2020 ◽

Vol 11 ◽

pp. 215145932093954

Author(s):

Katelyn Ragland ◽

Steven M. Cherney ◽

Jeffrey B. Stambough ◽

Simon C. Mears

Keyword(s):

Soft Tissue ◽

Prosthetic Joint Infection ◽

Motor Vehicle ◽

Tissue Injury ◽

Joint Infection ◽

Soft Tissue Injury ◽

High Energy ◽

Periprosthetic Fractures ◽

Cement Spacer ◽

Prosthetic Joint

Introduction: With the increase in knee and hip implants, these periprosthetic fractures will become more common especially as the population ages. Open periprosthetic fractures are rare and severe injuries and are more likely to be seen in high-energy injuries. They present challenges to the treating physician due to soft tissue damage, contamination of the existing implants, and the effects of polytrauma in the geriatric patient. Methods: . Results A 72-year-old woman was involved in a motor vehicle collision with multiple injuries including an open periprosthetic tibia and femur fracture. This was treated with initial washout and removal of loose tibial component with placement of a cement spacer. The knee was treated with staged revision using a protocol like that used after prosthetic joint infection. After complete soft tissue healing, the patient underwent successful revision with a megaprosthesis. The literature on open periprosthetic fractures is reviewed. Discussion and Conclusion: Open periprosthetic fractures present multiple challenges to the orthopedic surgeon. In the presences of poly trauma and soft tissue injury, we present an approach using staged surgery like that used for prosthetic joint infection.

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MANAGEMENT OF HIGH VELOCITY TIBIAL PLATEAU FRACTURES BY LIGAMENTOTAXIS USING ILIZAROV EXTERNAL FIXATOR

10.36106/ijsr/8235475 ◽

2021 ◽

pp. 33-35

Author(s):

Mayank Poddar ◽

Abhinav Sinha ◽

Amit Narang

Keyword(s):

Soft Tissue ◽

High Velocity ◽

Bone Grafting ◽

Tibial Plateau ◽

High Energy ◽

Tibial Plateau Fractures ◽

Type Iv ◽

Schatzker Type ◽

Duration Of Surgery ◽

The Mean

Background: Tibial plateau fractures resulting from high energy trauma, typically Schatzker type IV, V and VI pattern fractures are difcult to deal with due to poor overlying soft tissue cover. Ligamentotaxis with ilizarov ring xator can be a suitable denitive treatment option for such injuries with fewer associated complications as compared to internal xation. Patients and Methods: 30 patients within the age group of 18-80 years with Schatzker type IV, V and VI pattern injuries were included in the study. A four ring ilizarov assembly was used with knee spanning with a proximal femoral ring. The patients were followed for 12 months and evaluation was analyzed as per Rasmussen clinical and radiological criteria. Results: The mean age of patients in our study was 39.76 years. Twenty cases were Schatzker type VI, 7 cases were Schatzker type IV (with extensive soft tissue swelling following high velocity trauma) and only 3 cases were type V. The mean duration of surgery was 47±12 mins without bone grafting and 72±14 mins with bone grafting. The mean interval from injury to surgery was 2.36 days (range 1-5 days). Rasmussen total anatomical outcome was excellent in 14 patients(46.66%) and good in 16 patients(53.33%). Rasmussen total functional outcome was excellent in 21 patients(70%) and good in 9 patients(30%). Final Outcome was excellent in 22 patients(73.33%) and good in 8 patient(26.66%). Discussion: High velocity tibial plateau fractures, when treated with internal xation and plating, carry a higher risk of associated complications ranging from deep infections to even compartment syndrome. The rate of re-operation following internal xation in such injuries has been high with most of the re-surgeries being required within one year of primary xation which adds to the morbidity of the patient. Ligamentotaxis with ilizarov ring xation as denitive treatment in such cases can be a fruitful operation with lesser complications and early return to previous level of activity.

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Flaps in the management of open tibial fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191792 ◽

2019 ◽

Vol 5 (3) ◽

pp. 504

Author(s):

T. Karikalan

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Tibial Fractures ◽

Tissue Loss ◽

Wound Debridement ◽

Open Tibial Fractures ◽

Type Iii ◽

Soft Tissue Loss ◽

Flap Cover

Background: The prognosis in open fractures is primarily determined by the amount of soft tissue loss and the level of contamination. Severe open tibial fractures usually require combined orthoplastic approach in the management. Our aim is to study the effectiveness of soft tissue flaps in the management of type III B open tibial fractures.Methods: The study material consists of 20 cases of grade III B open tibial fractures admitted in our institution. Under anaesthesia, wound debridement was done and fracture stabilised with external fixator or IM nail depending upon the wound status. Patient underwent flap cover once the wound was fit. Periodic follow up was done.Results: Nonunion occurred in one patient (5%). Chronic osteomyelitis developed in two patients (10%). Deep infection occurred in three cases (15%). There was no secondary amputation in our series. The average union time of fracture was 30.1 weeks. Lower third fractures and those patients with extensive soft tissue injury, delayed flap cover and flap failure had longer union time.Conclusions: Fasciocutaneous flap has definitive role in the management of type III B open tibial fractures with soft tissue loss.

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