Flexible Intramedullary Nailing in High-Energy Tibial Fractures With Extensive Soft-Tissue Loss

2020 ◽  
Vol 10 (2) ◽  
pp. e0030-e0030
Author(s):  
Jung-Mo Hwang ◽  
Chan Kang ◽  
Deuk-Soo Hwang ◽  
Gi-Soo Lee ◽  
Jeong-Kil Lee ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Intramedullary Nailing ◽  
High Energy ◽  
Tibial Fractures ◽  
Tissue Loss ◽  
Flexible Intramedullary Nailing ◽  
Soft Tissue Loss

The Management of Open Tibial Fractures with Associated Soft-Tissue Loss

1981 ◽  
Vol 68 (1) ◽  
pp. 80-82 ◽  
Author(s):  
H. Steve Byrd ◽  
George Cierny ◽  
John B. Tebbetts
Keyword(s):  
Soft Tissue ◽  
Tibial Fractures ◽  
Tissue Loss ◽  
Open Tibial Fractures ◽  
Soft Tissue Loss

A review of 10 years of scapula injuries sustained by UK military personnel on operations

2017 ◽  
Vol 164 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Darren C Roberts ◽  
D M Power ◽  
S A Stapley
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Military Personnel ◽  
High Energy ◽  
Tissue Loss ◽  
Multiple Injuries ◽  
Severity Scores ◽  
Soft Tissue Loss ◽  
Scapula Fractures

BackgroundScapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel.MethodsAll UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004–2014).ResultsForty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (p<0.0001). Brachial plexus injuries occurred in 17%. While military personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united.ConclusionScapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.

Foot Salvage After Loss of the First and Second Metatarsal Rays with a Free Fibular Osteocutaneous Flap

2011 ◽  
Vol 101 (6) ◽  
pp. 531-536 ◽  
Author(s):  
Christopher J. Salgado ◽  
Chih-Hung Lin ◽  
David A. Fuller ◽  
Alissa N. Duncan ◽  
Liliana Camison ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
High Energy ◽  
Metatarsal Bone ◽  
Tissue Loss ◽  
Metatarsal Bones ◽  
Second Metatarsal ◽  
Independent Ambulation ◽  
Soft Tissue Loss ◽  
Osteocutaneous Flap

Severely comminuted fractures of the metatarsal bones with significant bone and soft-tissue loss have commonly subjected patients to proximal amputation procedures. We describe two patients who experienced high-energy traumatic injuries to their limbs that resulted in significant destruction of their first and second metatarsal bones with overlying soft-tissue trauma not amenable to local coverage. In both cases, a vascularized free fibular osteocutaneous flap was used to reconstruct the metatarsal bone defect and traumatized soft tissues so that a proximal amputation was avoided. At an average of 14 months of follow-up, both patients had recovered well and regained independent ambulation, with one patient being able to play soccer. We show that the free fibular osteoseptocutaneous flap is useful in reconstructing significant metatarsal bone defects and in avoiding amputations in this patient population. The skin component of the flap may be used to fill soft-tissue losses, and the fibula bone may be osteotomized so that more than one ray may be reconstructed. (J Am Podiatr Med Assoc 101(6): 531–536, 2011)

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 External Pin Fixation with Early Flap Coverage for Open Tibial Fractures with Soft Tissue Loss

1970 ◽  
Vol 11 (1) ◽  
pp. 28-32
Author(s):  
Md Shamsuzzaman ◽  
Md Anowarul Islam ◽  
Shah Mohammad Amanullah
Keyword(s):  
Soft Tissue ◽  
Tibial Fractures ◽  
Tissue Loss ◽  
Open Tibial Fractures ◽  
Type Iii ◽  
Pin Fixation ◽  
Injury Treatment ◽  
Radical Debridement ◽  
Soft Tissue Loss ◽  
Flap Cover

Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft tissue loss and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well vascularized soft tissue is presented. Eighteen patient with 20 type III and type III(a) wounds were treated in a prospective fashion employing a combined orthopedic and plastic surgical scheme based on the tenets of early radical debridement, a "second look" operation, muscle or fasciocataneus flap cover within the first 3 weeks for injury. All fractures united in a mean time of 6.0 months. The mean hospitalization was 6.2 weeks. There have been chronic infection, osteomyelitis nonunion, shortening or tissue breakdown. Keyword: Open tibial fractures, external pin fixation DOI:10.3329/jom.v11i1.4265 J Medicine 2010: 11: 28-32

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