scholarly journals Open tibial fracture with severe soft tissue injury and bone loss managed with ipsilateral fibular transport and its complications: a case report

2021 ◽  
Author(s):  
John Mukhopadhaya ◽  
Arvind Gupta ◽  
Amit K. Sinha
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Road Traffic ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
The Body ◽  
Soft Tissue Coverage ◽  
Time Duration ◽  
Ilizarov External Fixator ◽  
Wound Debridement

<p class="abstract">Massive segmental bone defects of tibia present as a challenging task to manage specially when associated with extensive soft tissue injury. A 30 year old male presented to Paras HMRI hospital, Patna, post road traffic accident with Gustilo Anderson 3B comminuted open tibia shaft fracture and with an external fixator in situ with a grossly inflamed and infected wound. Initially patient was managed with serial wound debridement and skin grafting was done early to obtain adequate soft tissue coverage. The patient then underwent application of Ilizarov external fixator with plan of one level fibular osteotomy for ipsilateral fibular transport. With good outcome of the procedure clinically and radiologically, Ilizarov fixator was removed after time duration of about 1.3 years and limb was immobilized in plaster of Paris (POP) cast which was removed after 8 weeks. Within 1 month of removal of POP cast the patient presented to hospital again with complaints of pain and instability when his leg was run over by his child’s bicycle while playing. Diagnosed as fracture of proximal (transported) fibula he was managed then with locking plates; one of which was used as an internal fixator and the other as external fixator which was outside the body and acted as a support to the operated limb. After about 1 year the external locking plate was removed and patient was able to bear weight on his extremities. Despite various modalities to treat massive tibial gap, fibular transport procedure with Ilizarov external fixator seems to be the most viable option.</p>

scholarly journals “Fixator-assisted Nailing” Technique for Closed Segmental Tibia Shaft Fracture with Extensive Soft Tissue Injury – A Case Report

2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Vivek M Sodhai ◽  
Chetan V Pradhan ◽  
Parag K Sancheti ◽  
Ashok K Shyam
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixator ◽  
Road Traffic ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Treatment Strategies ◽  
Soft Tissue Injuries ◽  
Definitive Treatment

Introduction: Segmental tibia fractures with extensive soft tissue injuries are rare and surgical intervention is challenging with no definitive treatment strategies. Case Report: A 52-year-old man presented with closed right segmental tibia and fibula fracture with extensive blistering of skin caused due to road traffic accident. Distal pulses were palpable and there were no signs of compartment syndrome and other systemic injuries. In the presence of extensive blistering, a monoplanar external fixator was applied within 24 h of injury. 3 weeks later, skin condition was conducive for internal fixation, and closed intramedullary multi-locking nailing was performed using the external fixator for reduction. Fracture healed at 15 months and patient had an excellent functional outcome with full knee range of motion at 2-years follow-up without any complications. Conclusion: Fixator-assisted nailing is a simple, minimally invasive, and easily reproducible technique that is useful in reducing the fracture and preventing axial rotation of the intercalary segment minimizing the damage to the periosteal blood supply. Our case also highlights the importance of temporary external fixator in soft tissue healing and making the skin conducive for internal fixation. Keywords: Devascularization, fixator-assisted nailing, intercalary segment, rotational displacement, segmental tibial fracture.

scholarly journals Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987398 ◽  
Author(s):  
Aik Saw ◽  
Zi Hao Phang ◽  
Mohammed Khalid Alrasheed ◽  
Roshan Gunalan ◽  
Mohammed Ziyad Albaker ◽  
...  
Keyword(s):  
Young Adults ◽  
Soft Tissue ◽  
External Fixator ◽  
Surgical Outcome ◽  
Tissue Injury ◽  
Femoral Condyle ◽  
Soft Tissue Injury ◽  
Gradual Correction ◽  
Soft Tissue Complication ◽  
Blount Disease

Purpose: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy. Methods: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA). Results: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection. Conclusions: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.

scholarly journals SPORTS INJURY AND REHABILITATION OF LOWER LIMB SOFT TISSUE

2021 ◽  
Vol 27 (8) ◽  
pp. 804-806
Author(s):  
Zhilin Zhu ◽  
Yuanyuan Ma
Keyword(s):  
Soft Tissue ◽  
Herbal Medicine ◽  
Lower Extremity ◽  
Chinese Herbal Medicine ◽  
Lower Limb ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Sports Injury ◽  
The Body ◽  
Chinese Herbal

ABSTRACT Introduction: the assessment and proper management of lower extremity soft tissue injury is very important. Because the mechanism and clinical manifestations of lower extremity soft tissue injury are varied, it is necessary to make an accurate assessment based on the specific situation of the patient. Objective: To explore the mechanism and rehabilitation methods of lower limb soft tissue sports injury. Methods: In clinical practice, external application of Chinese herbal medicine combined with cold compresses, massage, pot dipping, hot immersion irradiation and other methods were used. Results: The self-made Chinese herbal medicine external ointment, swelling and pain relieving Chinese herbal medicine wine combined with electromagnetic wave therapy instrument is one of the commonly used and effective methods to treat sports injury of lower extremity soft tissue in health care experimental centers. It has the most remarkable effect on local burning, stasis, swelling and pain caused by the soft tissue injury of various lower limbs in various parts of the human body. Conclusions: Timely functional rehabilitation training after sports injury can promote the functional healing and rehabilitation of the body after injury, maintaining the good functional state of each organ system of the body. Level of evidence II; Therapeutic studies - investigation of treatment results.

scholarly journals Treatment of Open Proximal Humerus Fracture by Gunshot

2012 ◽  
Vol 15 (1) ◽  
pp. 37-42
Author(s):  
Sung Jae Kim ◽  
Jae Hoo Lee ◽  
Yong Min Chun
Keyword(s):  
Internal Fixation ◽  
External Fixator ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Fracture Site ◽  
Humerus Fracture ◽  
Wound Debridement ◽  
Fracture Management

PURPOSE: To consider the proper managment of proximal humerus fracture on gunshot wounds.MATERIALS AND METHODS: A 28-year-old male patient, who sustained a gunshot injury on the left arm 5 days ago, was admitted through the emergency department. Although he underwent an emergency surgery (bullet fragment removal and debridement), there remained bullet fragments around the proximal humerus fracture site. The wound seemed to be infected and a partial dehiscence occurred. No neurologic deficit was noted. Immediate exploration and debridement were performed, and an external fixator was applied to restore the anatomical alignment and manage the wounds. Intravenous antibiotics were administered. On the 9th postoperative day, wound debridement was done again, and cement beads mixed with antibiotics were inserted. After two weeks, the external fixator was removed, and the pin sites were closed after debridement. One week later, the open reduction and internal fixation with locking compression plate and screws were done.RESULTS: At 3 months after the internal fixation, the bone union was obtained with satisfactory alignment of the humerus.CONCLUSION: The severity of the soft tissue injury influences the fracture management plan. Further, the risk on lead toxicity should be considered.

scholarly journals Discomfort/Pain and Tissue Oxygenation at the Lower Limb During Circumferential Compression: Application to Soft Exoskeleton Design

2020 ◽  
Vol 62 (3) ◽  
pp. 475-488 ◽  
Author(s):  
Tjasa Kermavnar ◽  
Kevin J. O’Sullivan ◽  
Adam de Eyto ◽  
Leonard W. O’Sullivan
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Near Infrared ◽  
Tissue Oxygenation ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
The Body ◽  
Subjective Perception ◽  
Deep Tissue ◽  
Exoskeleton Design

Objective To establish the relationship between circumferential compression on the lower limb during simulated ramp and staircase profile loading, and the resultant relationship with discomfort/pain and tissue oxygenation. Background Excessive mechanical loading by exoskeletons on the body can lead to pressure-related soft tissue injury. Potential tissue damage is associated with objective oxygen deprivation and accompanied by subjective perception of pain and discomfort. Method Three widths of pneumatic cuffs were inflated at the dominant thigh and calf of healthy participants using two inflation patterns (ramp and staircase), using a computer-controlled pneumatic rig. Participants rated discomfort on an electronic visual analog scale and deep tissue oxygenation was monitored using near infrared spectroscopy. Results Circumferential compression with pneumatic cuffs triggered discomfort and pain at lower pressures at the thigh, with wider cuffs, and with a ramp inflation pattern. Staircase profile compression caused an increase in deep tissue oxygenation, whereas the ramp profile compression decreased it. Conclusion Discomfort and pain during circumferential compression at the lower limb is related to the width of pneumatic cuffs, the inflation pattern, and the volume of soft tissue at the assessment site. The occurrence of pain is also possibly related to the decrease in deep tissue oxygenation during compression. Application Our findings can be used to inform safe and comfortable design of soft exoskeletons to avoid discomfort and possible soft tissue injury.

scholarly journals Bone Transport of Tibia

2018 ◽  
Vol 14 (15) ◽  
pp. 12
Author(s):  
Omer Ali Rafiq Barawi ◽  
Zmnako J. Amen
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
External Fixator ◽  
Road Traffic ◽  
Tissue Loss ◽  
Ilizarov External Fixator ◽  
Ilizarov Frame ◽  
Group A ◽  
Group B ◽  
Soft Tissue Loss

This is a comparative study to evaluate the outcome of forty patients with bone loss in tibia using conventional external fixation device for group A while for group B using Ilizarov external fixator device each group consists of 20 patients, based on principles of distractive osteogenesis. Patients and methods: Forty patients with bone loss of 4 to 14 centimeters in tibia between April 2011 and April 2016 were treated, ages (15-65 years); female to male ratio was 6:34. The cause of defects in tibia was fracture due to road traffic accident (20 cases), bullet injury to leg (8 cases), gap nonunion (8 cases) and infected non unions(4 cases). They were divided into two groups each consists of 20 patients, conventional external fixator used for group A while for group B Ilizarov external fixator device was used with performing transverse corticotomy proximal or distal to the gap for both groups. Results: Evaluation of results was done according to Association for Study and Application of Methods of Ilizarov (A.S.A.M.I.) scoring system and it revealed that both functional and bony results were better in group B than group A. Conclusions: Fixation of the bone by Ilizarov frame gives more rapid union of the bone, less chance of pin tract infection and cosmetically more preferable because of smaller scar tissue of entry of K wires than Schanz pins. Prevention and treatment of equinus deformity and clawing of the toes can be done by extending the Ilizarov frame to correct them. In cases of severe soft tissue loss it is better to apply conventional external fixator as a provisional fixator till the soft tissue loss and swelling will be diminished.

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

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.

scholarly journals CASE SUMMARY ON ACUTE WOUND MANAGEMENT OF EXTENSIVE FACIAL SOFT TISSUE INJURY

2020 ◽  
pp. 1-3
Author(s):  
Sunita Das ◽  
Hironya Borah ◽  
Arup Kakati
Keyword(s):  
Soft Tissue ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Wound Management ◽  
Aesthetic Outcome ◽  
Facial Soft Tissue ◽  
Physical Strain ◽  
The Face

Injuries to the face are commonly encountered in the Emergency department and is usually seen following road traffic accidents. It may include injuries to the soft tissue or bones of the face. Soft tissue injuries of the face almost always include injuries to the nose, as it is the most prominent feature of the face. These injuries are often not life-threatening, but its mismanagement can hamper the functional and aesthetic outcome leading to permanent mental and physical strain. Thus, to achieve a suitable final outcome, proper understanding of the facial anatomy, assessment of the wound and its proper management is necessary. This report discusses the case of a middle aged man who suffered from contaminated facial soft tissue injury following road traffic accident. Good functional and aesthetic outcome was achieved with special emphasis on the proper assessment, irrigation and meticulous repair of the wound. Follow-up of the patient was done after being discharged from the hospital.

scholarly journals Flaps in the management of open tibial fractures

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> Fasciocutaneous flap has definitive role in the management of type III B open tibial fractures with soft tissue loss.</p><p class="abstract"> </p>

scholarly journals Epidemiology of Maxillofacial Fracture – A Hospital Based Study

2020 ◽  
Vol 17 (2) ◽  
pp. 23-27
Author(s):  
Arun Kumar Mahat ◽  
Gopal Gurung ◽  
Merina Shrestha ◽  
Bishwanath Chaudhary
Keyword(s):  
Head Injury ◽  
Soft Tissue ◽  
Road Traffic ◽  
Bone Fractures ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Maxillofacial Trauma ◽  
Study Patient ◽  
Facial Bone ◽  
Accompanying Injuries

Introduction: Maxillofacial trauma is the most common problem seen by maxillofacial surgeons in Nepal. The causes of facial fractures are road traffic accidents (RTA), assaults, falls, gunshot wounds, domestic violence, sports and work injuries. Maxillofacial injury varies from soft tissue injury to facial bone fractures. This study was conducted to assess the burden of maxillofacial trauma in mid-western and far-western regions of Nepal. Material and Method: Patients with maxillofacial fractures admitted in dental ward of NGMCTH, Kohalpur, from April 2017 to April 2019 were included in the study. Patients having soft tissue injury without facial bone fractures and OPD cases were excluded from the study. Patient demographics, mechanism of injury, associated soft tissue injury, accompanying injuries to other parts of body and facial bone fractures were recorded. Patient were treated by open reduction internal fixation or lateral compression splint with circum-mandibular wiring or managed conservatively as necessary. Result: A total of 87 patients were included in the study. The age of patient ranged from 2 years to 67 years with a mean of 26.87 years. Most of the injuries occurred between the age group of 20-29 years with male: female ratio 5.2:1. The most frequent cause of facial bone fracture was RTA (51.7%) and the most frequently fractured facial bone was mandible. Contusion 54(49.5%) was the most common associated soft tissue injury. Head injury 20(52.6%) was the most common accompanying injury to other parts of body. The mean duration of hospital stay was 6.29. Conclusion: Male patient in their third decade mostly had mandible fracture due to road traffic accident. Head injury was the most common accompanying injury. Contusion was the most common type of associated soft tissue injury.  

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