scholarly journals Operative Choice for Open Tibial Shaft Fracture in Children: A Comparative Study of External Fixator Vs. Elastic Stable Intramedullary Nail

2021 ◽  
Author(s):  
Pan Hong ◽  
Saroj Rai ◽  
Xin Tang ◽  
Ruikang Liu ◽  
Jin Li
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Shaft Fracture ◽  
Tibial Fractures ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Elastic Stable Intramedullary Nail ◽  
Open Tibial Fractures ◽  
Significant Difference

Abstract IntroductionExternal fixator (EF) is a preferred choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.Material and methodsPatients aged 5-11 years old with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF (n = 55) and ESIN (n = 37) group. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow up less than 24 months or incomplete medical records were also excluded. ResultsIn all, fifty-five patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no patient of nonunion and malunion in either group. The incidence of implant prominence was higher in the ESIN group (16%) than those in the EF group (0), P < 0.001. The angulation was higher in the EF group than ESIN group in coronal and sagittal plane, P < 0.001. The radiological union was faster in the ESIN group (7.0 ± 0.9, weeks) than those in the EF group (9.0 ± 2.2), P < 0.001. Limb length discrepancy (LLD) was significantly longer in the EF group (12.1 ± 4.4, mm) than those in the ESIN group (7.3 ± 4.3, mm), P < 0.001. ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator, but with less complications including superficial infection, residual angulation and refracture after hardware removal.

scholarly journals External fixation versus elastic stable intramedullary nailing in the treatment of open tibial shaft fractures in children

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Pan Hong ◽  
Saroj Rai ◽  
Xin Tang ◽  
Ruikang Liu ◽  
Jin Li
Keyword(s):  
Tract Infection ◽  
Clinical Outcomes ◽  
External Fixator ◽  
Shaft Fracture ◽  
Tibial Fractures ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Open Tibial Fractures ◽  
Pin Tract Infection

Abstract Introduction External fixator (EF) is a popular choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively. Methods Patients aged 5–11 years with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF and ESIN groups. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow-up < 24 months or incomplete medical records were also excluded. Results In all, 55 patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no statistically significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no case of nonunion and malunion in either group. The angulation at the latest follow-up was higher in the EF group than the ESIN group (P < 0.01). The radiological union was faster in the ESIN group (7.0 ± 0.9 weeks) than those in the EF group (9.0 ± 2.2 weeks) (P < 0.01). Limb length discrepancy (LLD) was more in the EF group (12.1 ± 4.4, mm) than in the ESIN group (7.3 ± 4.3, mm) (P < 0.01). Conclusion ESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator. Pin tract infection is the most troublesome complication in the EF group while implant prominence is a nuisance in the ESIN group.

scholarly journals Management of high-energy tibial shaft fractures using the hexapod circular external fixator

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Jialin Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
High Energy ◽  
Bone Union ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Clinical Visit ◽  
Shaft Fractures ◽  
Definitive Management ◽  
Tibial Shaft Fractures

Abstract Background The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures. Methods The study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit. Results All patients remained in the HEF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions Definitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.

Clamp external fixator for IIIb open tibial shaft fracture

1999 ◽  
Vol 12 (3) ◽  
pp. 557
Author(s):  
Jeung Tak Suh ◽  
Byung Guk Park ◽  
Chong Il Yoo
Keyword(s):  
External Fixator ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft

scholarly journals Proximal peroneal artery traumatic pseudoaneurysm following a compound proximal tibial shaft fracture managed with an external fixator: A case report

2019 ◽  
Vol 27 (1) ◽  
pp. 89-92
Author(s):  
Malinda Rasith Ileperuma ◽  
Badra Hewavithana
Keyword(s):  
External Fixator ◽  
Rare Complication ◽  
Shaft Fracture ◽  
Sudden Onset ◽  
Peroneal Artery ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Artery Pseudoaneurysm ◽  
Initial Injury ◽  
High Index Of Suspicion

A case of post-traumatic proximal peroneal artery pseudoaneurysm following a proximal tibial shaft fracture, complicated by acute compartment syndrome, fixed using an external fixator, in a 22-year-old female is presented. She was investigated for sudden-onset bleeding from the external fixator pin site, 6 weeks after the initial injury, was anaemic and diagnosed with a pseudoaneurysm at lower limb angiography. Contrast leak from the site of pseudoaneurysm was noted and open surgery with ligation of the pseudoaneurysm was performed. This rare complication of a proximal tibial shaft fracture has to be considered in patients presenting with acute bleeding from the surgical site or from pin sites after a significant lag period and requires a high index of suspicion.

scholarly journals Sciatic obturator femoral technique versus spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. A randomised trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hoda Shokri ◽  
Amr A. Kasem
Keyword(s):  
Adverse Events ◽  
Spinal Anaesthesia ◽  
External Fixator ◽  
Randomised Trial ◽  
Study Groups ◽  
Tibial Fractures ◽  
Hyperbaric Bupivacaine ◽  
Ilizarov External Fixator ◽  
Open Tibial Fractures ◽  
Significant Difference

Abstract Background Peripheral nerve block is preferable for lower extremity surgery because it sufficiently blocks pain pathways at different levels providing excellent anaesthesia at the site of surgery. We designed this study to compare the efficacy and safety of SOFT block (sciatic-obturator-femoral technique) compared with spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. Methods One hundred and seven patients ASA I, II scheduled for fixation of open tibial fractures using Ilizarov external fixator. The patients were randomly allocated to receive either spinal anaesthesia or SOFT block. In spinal anaesthesia group, patients received spinal anaesthesia with hyperbaric bupivacaine 0.5% (7. 5-10mg). In SOFT group, patients received SOFT block with bupivacaine 0.25%. Primary endpoint included the duration of analgesia. The secondary endpoints included patient satisfaction scores, visual analogue scores, incidence of adverse events as vomiting, systemic toxicity from local anaesthetic drug and time to first effect of the techniques. Results The duration of SOFT block and time to first analgesic dose in SOFT group was significantly longer (p < 0.001). There was no significant difference between the study groups regarding satisfaction scores, the incidence of cardiovascular collapse, seizures and paraesthesia. Pain scores were significantly lower in SOFT group at 3,6,12 h postoperative (p < 0.001). The time to the first effect was significantly longer in SOFT group (p < 0.001). Conclusion SOFT is a feasible technique of local anaesthesia for control of postoperative pain with unremarkable adverse events compared with spinal anaesthesia, in patients undergoing fixation of tibial fractures using Ilizarov external fixator. Trial registration This trial was retrospectively registered at ClinicalTrials.gov. registry number: NCT03450798 on February 20, 2018.

Sign in / Sign up

Export Citation Format

Share Document