scholarly journals Outcome analysis of surgical management of type 2, 3a and 3b open fractures of distal 2/3rd tibial diaphysis using external fixators

2020 ◽  
Vol 6 (5) ◽  
pp. 939
Author(s):  
Dibin K. Thomas ◽  
Nishara M. S.
Keyword(s):  
Functional Outcome ◽  
External Fixator ◽  
Evaluation System ◽  
Open Fractures ◽  
Definitive Treatment ◽  
Fixation Method ◽  
Diabetic Patients ◽  
External Fixators ◽  
Functional Evaluation ◽  
Serial Casting

<p><strong>Background:</strong> There is confusion regarding ideal fixation method for intermediate grades of open fractures of tibia. In distal 2/3rd of tibia the blood supply is precarious and so it further increases the confusion. Purpose of this study is to evaluate effectiveness of external fixator as definitive treatment in these fractures.</p><p><strong>Methods:</strong> 55 patients with type2, 3A or 3B open fractures of distal 2/3rd tibia were studied. External fixator applied at the time of debridement is removed and cast applied once wound is healed. Follow up at 1, 3, 6 and 9 months recorded. Union assessed using rust scoring system. Functional outcome assessed using Modified Functional Evaluation System by Karlstrom- Olerud after patients are mobilized.</p><p><strong>Results:</strong> Union rate was 74.5%.Functional outcome was satisfactory in 34%, moderate function in 32% and good function in 24.4%. In 7.3% the function was poor. Only one case gave excellent function.</p><p>Among diabetic patients 71.4% developed wound infection and all developed pin tract infection showing strong association between diabetes and infection.</p><p><strong>Conclusion:</strong> Though external fixation followed by serial casting technique gave fare outcomes, there is scope for better results and so the option of other methods of treatment should not be excluded. There is a significant association between diabetes and infection and so special care and covigilance is advised in diabetic patients.</p>

scholarly journals Locally-developed External Fixators as Definitive Treatment of Open Tibia Diaphyseal Fractures: A Clinical Prospective Study Conducted in Ivory Coast

2020 ◽  
Author(s):  
Kouamé Jean-Eric Kouassi ◽  
Jean Régis Akobé ◽  
Aya Adélaïde Natacha Kouassi ◽  
Loïc Founkoué ◽  
Christine Detrembleur ◽  
...  
Keyword(s):  
Fracture Healing ◽  
External Fixator ◽  
Ivory Coast ◽  
Definitive Treatment ◽  
External Fixators ◽  
Negative Consequences ◽  
Clinical Trial Registry ◽  
Septic Complications ◽  
Non Union ◽  
Diaphyseal Fractures

Abstract Background: This study sought to evaluate the effectiveness of locally-developed external fixators (LDEF) as definitive treatment for open tibia diaphyseal fractures (OTDF) in Ivory Coast.Methods: Gustilo I, II and IIIA OTDFs of patients admitted within 24 hours of injury were prospectively included and treated with a locally-developed external fixator. The rates of union, mal-union, septic complications, as well as the functional results were assessed, in addition to the LDEF construct’s integrity. Predictive factors of failure or poor results were assessed.Results: Overall, 40 OTDF patients were admitted within 24 hours of injury. Gustilo I, II and IIIA fractures were observed in three, 13, and 24 patients, respectively. Uneventful fracture healing was obtained in 29 cases, with an average union time of 8.47 months. Mal-union and non-union were registered in three and four cases, respectively. Pin-track infection (PTI) was observed in 13 cases, and deep infection in seven. Infection resolved in all patients except four, who developed chronic osteomyelitis. None of the non-unions were associated with an infection. The overall functional result was satisfactory in 32 patients. PTI was the only predictive factor for chronic infection. Biplanar frames, when compared to monoplanar constructs, were associated with a significantly improved functional outcome.Conclusion: In comparison with the results obtained in the same environment without a locally-developed external fixator, the provision of such a device improved significantly the OTDF management, as it provided better stability and superior fracture healing rates. PTI remains an essential problem but with, hopefully, limited negative consequences. Trial registration: This study protocol was registered in Pan African Clinical Trial Registry under N°PACTR202009854874448. Date of registration 28 September 2020 ‘retrospectively registered’. www.pactr.org.

scholarly journals Outcome of external fixator in the treatment of intertrochanteric fracture in elderly patients with co-morbidities

2019 ◽  
Vol 7 (1) ◽  
pp. 3-7
Author(s):  
Deepak Kumar Dutta ◽  
R, Sinha
Keyword(s):  
Elderly Patients ◽  
Functional Outcome ◽  
External Fixator ◽  
Intertrochanteric Fracture ◽  
Harris Hip Score ◽  
External Fixators ◽  
Intertrochanteric Fractures ◽  
Early Ambulation ◽  
Medical Comorbidities ◽  
Mean Time

Background and Objectives: Incidence of intertrochanteric fracture is rising because of increasing number of elderly. They tend to have many comorbidities of different systems; therefore, major surgeries are not possible at times. In these patients, external fixator can be an option as it promotes early ambulation, thereby preventing recumbency-associated complications. Material and Methods: Elderly patients of interetrochanteric fracture and with medical comorbidities were managed with external fixator. Functional outcome was measured by Harris Hip Score (HHS) on first post-operative day and in follow ups on 4, 12, and 24 weeks. Results: Thrity patients (19 males, 11 females), of mean age 77.63 years (SD=9.06) were studied. HHS scores steadily increased from 37.6±5.28 on the first post-operative dayto 49.43±6.9 on 4 weeks, 59.83±7.17 on 12 weeks, and 72.47±4.17 on 24 weeks. The changes were all very highly significant (all p=0.000). Mean time taken to union was 14.67±2.28 weeks. None of the patients had recumbency-related complications. Conclusion: External fixators for intertrochanteric fractures in medically comorbid elderly patientsis effective in promoting ambulation and preventing recumbency-related complications.

scholarly journals Study on the relationship between the timing of conversion from external fixation to internal fixation and infection in the treatment of open fractures of extremities

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zelin Ye ◽  
Shanwen Zhao ◽  
Canjun Zeng ◽  
Ziheng Luo ◽  
Song Yuan ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Soft Tissues ◽  
Open Fractures ◽  
External Fixators ◽  
Type I ◽  
Infection Rates ◽  
Local Conditions ◽  
The Relationship

Abstract Objective To investigate the relationship between the infection rate and the timing of replacement of temporary external fixators with internal fixation, and the timing of immediate or delayed internal fixation after removal of temporary external fixation in the staging treatment modality of open fractures of extremities. Methods A retrospective analysis was performed on 122 cases of open fractures of extremities. External fixators were applied at the early stage and replaced with internal fixation when the condition of soft tissues improved and inflammatory indexes dropped to the normal range or showed a steady downward trend. Depending on the carrying time of external fixators after wound closure or healing, the patients were divided into three groups; the carrying time of groups A, B, and C was ≤ 14 days, 15–28 days, and > 28 days, respectively. Depending on the immediate or delayed internal fixation after removal of external fixator, patients were divided into group a (immediate internal fixation after removal of external fixator) and group b (delayed internal fixation after removal of external fixator, 5–7 days later). Results The infection rates of groups A, B, and C were 6.5%, 5.9%, and 23.3%, respectively. The differences among the three groups were statistically significant (P < 0.05). The infection rates of different Gustilo–Anderson fractures were as follows: no cases of infection out of 10 cases with type I fracture (0%); two cases of infection out of 35 cases with type II fracture (5.7%); three cases of infection out of 36 cases with IIIa fracture (8.3%); five cases of infection out of 28 cases with IIIB fracture (17.9%); and five cases of infection out of 13 cases with IIIC fracture (38.5%). The differences among the five groups were statistically significant. Conclusions The occurrence of infection of open fractures of extremities is associated with the fracture severity (Gustilo classification). For open fractures of Gustilo types I and II, the final internal fixation should be placed as soon as possible when the recovery of general and local conditions is good and the infection is controlled.

Methods of Evaluation of the Functional Results of Flexor Tendon Repair of the Fingers

1985 ◽  
Vol 10 (1) ◽  
pp. 60-61 ◽  
Author(s):  
A. B. NIELSEN ◽  
P. Ø. JENSEN
Keyword(s):  
Functional Outcome ◽  
Standard Method ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Functional Results ◽  
Functional Evaluation ◽  
Flexor Tendon Repair ◽  
Methods Of Evaluation ◽  
Method Of Measurement ◽  
No Man's Land

The methods used by Buck-Gramcko, Kleinert and Tsuge in evaluating the functional results of flexor tendon repair were each applied to assess the functional outcome in sixty-seven fingers where both tendons had been severed in “no man's land”. The method of Buck-Gramcko gave the highest rating, and the three methods showed evident differences in the results of evaluation after surgery. The study suggests a need for one standard method of measurement and recording, if a comparison of results after flexor tendon repair is to be of value. We found that the method of Buck-Gramcko incorporated the most essential features in the functional evaluation.

scholarly journals Functional Outcome in Sarcomas Treated With Limb-Salvage Surgery or Amputation

Sarcoma ◽  
1998 ◽  
Vol 2 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Rikke Johansen ◽  
Ole S. Nielsen ◽  
Johnny Keller
Keyword(s):  
Functional Outcome ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Univariate Analysis ◽  
Soft Tissue Sarcomas ◽  
Post Treatment ◽  
Limb Salvage Surgery ◽  
Functional Evaluation ◽  
Functional Scores

Purpose.In all patients treated at the Centre for Bone and Soft Tissue Sarcomas of Aarhus the functional outcome is prospectively evaluated by use of the Enneking system for the functional evaluation after surgical treatment of tumours of the musculoskeletal system. This system has been accepted by the Musculoskeletal Tumour Society and the International Symposium on Limb Salvage.Patients/methods.In the present study the functional outcome after limb-salvage surgery (89 patients) and amputation (58 patients) was compared. In the limb-salvage group the treatment was surgery alone in 50% and surgery combined with either radiotherapy in 39% or chemotherapy in 11%. Inclusion criteria were: Deep seated extremity sarcomas, age >14 years, more than 1 year post-treatment follow-up time and alive at the end of the study. Median age was 49 years (range 14–88 years). Median tumour diameter was 8 cm (range 1–20 cm), median follow-up time was 4.8 years (range 1–11 years). Wilcoxon andχ2-tests were used for statistical analyses.Results.The two groups were comparable according to age, sex, size of tumour, type of tumour, location of tumour, as well as post-treatment follow-up time. The functional scores were significantly higher after limb-salvage surgery as compared to amputation, the median scores being 85 and 47, respectively (p<0.001). A similar difference was observed if the Enneking scores were subdivided into general health-related scores and extremity-related scores. No association was found between functional scores and the following factors by use of univariate analysis: size of tumour, radiation therapy, localization of tumour and surgical margin.Discussion.We conclude that this study indicates that limb-salvage surgery is associated with a better functional outcome than that observed after amputation. However, whether this also indicates a difference in quality of life needs further studies.

Preventing Air Leakage in Negative Atmospheric Pressure Therapy for Open Fractures Treated With External Fixators

2013 ◽  
Vol 38 (12) ◽  
pp. 2520 ◽  
Author(s):  
İlhami Oğuzhan Aydoğdu ◽  
Engin Yosma ◽  
Tekin Şímşek ◽  
Musa Kemal Keleş
Keyword(s):  
Atmospheric Pressure ◽  
Open Fractures ◽  
External Fixators ◽  
Air Leakage ◽  
Pressure Therapy

scholarly journals A COMPARATIVE STUDY OF IN VIVO EFFECT OF PERCUTANEOUS BONE MARROW INJECTION VS WITHOUT INJECTION ON UNION OF OPEN TIBIAL SHAFT FRACTURES WITH EXTERNAL FIXATOR

2020 ◽  
pp. 1-2
Author(s):  
Hrishikesh Desai ◽  
Kirtiraj G ◽  
Abhay P
Keyword(s):  
Bone Marrow ◽  
External Fixator ◽  
Autologous Bone Marrow ◽  
Tibial Fractures ◽  
External Fixators ◽  
Open Tibial Fractures ◽  
Autologous Bone ◽  
Group 2 ◽  
Radiological Union

Background : Open tibial fractures are notorious fractures because the open wound leaves us with limited options and means multiple operations with long intervals for the patient. The usual method of treatment of contaminated, late presenting and complicated fractures is a temporary external fixator followed by conversion into a costly definitive procedure once the wound has healed. The secondary definitive procedure also means extra cost in an already economically stressed patient.In our set up we have to often let patients leave with a plaster cast after removing the external fixator for economic constrains. Per cetaceous autologous bone marrow injection while the patient is on external fixator is one alternative that we have tried to deal with this problem hoping for a primary union without any costly intervention. Materials and methods : We had 42 cases of open tibial fractures which were treated with external fixator and per cutaneous bone marrow injection while 38 other cases which were used as control with only the external fixator and no injections. We included open fractures of only Gustilo Anderson type II,IIIA and B for our study. Study was conducted between period of June 2012 and December 2013 at SBKS medical college . Results : In group one, 34 of the 42 patients had a radiological union before 12 weeks while another 2 in 16 weeks. For group 2 , only 16 of the 38patients had radiological union at 12 weeks and no more at 16 weeks. The average time of union for group 1 was 10 weeks while of group 2 was 12 weeks .Function of the union cases of both the groups was similar in all aspects including distance of walking and ability to carry out daily activities. Conclusion : Per cutaneous autologous bone marrow injections are cheap , easily available and successful alternative to a secondary procedure for open tibial fractures on external fixators.

Methyl methacrylate in external fixation of supracondylar humerus fractures: An experimental study

2018 ◽  
Vol 232 (10) ◽  
pp. 1025-1029
Author(s):  
Ali Güleç ◽  
Mehmet Ali Acar ◽  
Bahattin Kerem Aydin ◽  
Teyfik Demir ◽  
Mustafa Özkaya
Keyword(s):  
Methyl Methacrylate ◽  
External Fixation ◽  
External Fixator ◽  
External Fixators ◽  
Three Point Bending ◽  
Fixation Methods ◽  
Supracondylar Humerus Fractures ◽  
Methacrylate Group ◽  
Humerus Fractures ◽  
K Wires

Supracondylar humerus fractures are common fractures around the elbow. Open fractures, comminuted metaphyseal fractures and also fractures with bone loss may need to be treated with external fixators. The aim of this study is to compare two different external fixators, tubular external fixators and polymethyl methacrylate with K wires external fixators, with regard to stiffness and stability for metaphyseal-diaphyseal osteotomies of distal humerus close to the joint. Six matched pairs (24 specimens) of second-generation sawbone humerus were prepared in a standard fashion to create a metaphyseal fracture, 5 cm proximal to the distal joint line of humerus and were randomly divided into two groups of 12 specimens each. Each sawbone humerus was osteotomized transversely at the mid-olecranon fossa with a 2-mm oscillating saw to simulate a Gartland type III fracture. The osteotomy was then reduced and stabilized using two different external fixation methods: carbon tubular external fixator with Schanz screws and methyl methacrylate with multiple K wires. Three-point bending and torsion tests were performed on the specimens. Bending and torsional stiffness of specimens were obtained for the fixation methods. According to the results of the study, the methyl methacrylate group has provided higher stiffness than classical tubular fixator with Schanz screws in three-point bending test (7.79 ± 2.33 N/mm vs 3.78 ± 1.18 N/mm, p = 0.006). The methyl methacrylate group also showed better stiffness in torsion test (0.12 ± 0.042 N m/° vs 0.067 ± 0.013 N m/°, p = 0.02). We determined for the first time in literature that external fixation with methyl methacrylate was significantly superior to the classical tubular external fixator with Schanz screws with regard to stiffness and stability under three-point bending and torsional loads. Moreover, methyl methacrylate is inexpensive and easily applied.

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