scholarly journals Treatment of open tibial shaft fracture with soft tissue and bone defect caused by aircraft bomb: Case report

2010 ◽  
Vol 138 (7-8) ◽  
pp. 510-514 ◽  
Author(s):  
Zoran Golubovic ◽  
Goran Vidic ◽  
Srbobran Trenkic ◽  
Zoran Vukasinovic ◽  
Aleksandar Lesic ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibial Fracture ◽  
Healing Process ◽  
Shaft Fracture ◽  
Bone Defects ◽  
Plaster Cast ◽  
Tibial Shaft Fracture ◽  
Wound Debridement ◽  
Bone Fixation ◽  
Tissue Defects

Introduction. Aircraft bombs can cause severe orthopaedic injuries. Tibia shaft fractures caused by aircraft bombs are mostly comminuted and followed by bone defects, which makes the healing process extremely difficult and prone to numerous complications. The goal of this paper is to present the method of treatment and the end results of treatment of a serious open tibial fracture with soft and bone tissue defects resulting from aircraft bomb shrapnel wounds. Case Outline. A 26-year-old patient presented with a tibial fracture as the result of a cluster bomb shrapnel wound. He was treated applying the method of external bone fixation done two days after wounding, as well as of early coverage of the lower leg soft tissue defects done on the tenth day after the external fixation of the fracture. The external fixator was removed after five months, whereas the treatment was continued by means of functional plaster cast for another two months. The final functional result was good. Conclusion. Radical wound debridement, external bone fixation of the fracture, and early reconstruction of any soft tissue and bone defects are the main elements of the treatment of serious fractures.

Serum Osteocalcin, Total and Bone-Specific Alkaline Phosphatase following Isolated Tibial Shaft Fracture

1996 ◽  
Vol 33 (3) ◽  
pp. 196-200 ◽  
Author(s):  
Shirley A Bowles ◽  
Nazeer Kurdy ◽  
Alison M Davis ◽  
Michael W France ◽  
David R Marsh
Keyword(s):  
Alkaline Phosphatase ◽  
Phosphatase Activity ◽  
Alkaline Phosphatase Activity ◽  
Healing Process ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Post Injury ◽  
Specific Alkaline Phosphatase ◽  
Bone Specific Alkaline Phosphatase

We report the changes in osteocalcin concentrations and in total and bone specific alkaline phosphatase activity occurring in the twenty week period following tibial shaft fracture in 20 subjects. Bone formation during the healing process is reflected by progressive increases in the concentration of osteocalcin and bone specific alkaline phosphatase after week 5 and the latter correlated with the height and weight of the subject. In the early post injury period, total alkaline phosphatase activity increased whereas that of the bone isoenzyme initially fell, starting to rise again during the second week. After an immediate post injury rise, osteocalcin concentration also decreased, reaching a nadir by week 5. As only three of our subjects demonstrated delayed union, we have not been able to demonstrate that biochemical monitoring of the healing process can provide an indication of prognosis in tibial shaft fracture.

scholarly journals A clinical study of management of Fournier’s gangrene in a rural hospital

2018 ◽  
Vol 5 (4) ◽  
pp. 1524
Author(s):  
Purushotham T. Shivaraju ◽  
Ponnappa B. Ganapathy ◽  
Naveen N. ◽  
Pruthvika N.
Keyword(s):  
Soft Tissue ◽  
Hospital Stay ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Surgical Reconstruction ◽  
Reconstructive Procedure ◽  
Soft Tissue Defects ◽  
Fournier's Gangrene ◽  
Wound Debridement ◽  
Tissue Defects

Background: Fournier’s gangrene is a potentially life threatening synergistic necrotising fascitis of external genitalia and perineal tissues. It commonly affects young men but can also affect women and children. The use of broad spectrum antibiotics and serial wound debridement is the main stay of treatment. The reconstruction of soft tissue defect following the debridement is a challenging task. The purpose of this study is to evaluate the surgical reconstruction methods of soft tissue defects due to Fournier's gangrene.Methods: This was a prospective study conducted in Adichunchanagiri Institute of Medical Sciences from January 2015 to December 2017. All patients with necrotizing fascitis of external genitalia and perineum, irrespective of age and gender, were included. Parameters such as age, gender, aetiology, predisposing factors, clinical features, defect location, type of bacterial flora, sort of reconstructive procedure used, and duration of hospital stay, post-operative pain, patient satisfaction and mortality, if any, were studied. The choice of reconstructive procedure was based on severity of defect, availability of local tissue and patient preference.Results: Out of 31 cases included in the study, 30 patients underwent reconstructive procedures. The age range was 4 to 74 years (mean 38.5). The commonest presentation was pain, scrotal swelling and fever. The most common aetiology was urogenital diseases. 10 patients were treated by split-thickness skin graft, 5 by secondary suturing, 2 by unilateral superomedial thigh flap, 4 by bilateral superomedial thigh flap, 5 by tensor fascia lata flap, 2 by medial thigh V-Y advancement flap, 2 with perineal artery flap and one case healed by secondary intention.Conclusions: This study suggests that earlier presentation, with early diagnosis and intervention with prompt debridement and appropriate, appropriate antibiotics are the main stays of treatment. The resulting soft tissue defects following wound debridement required surgical reconstruction, except in one case, thus decreasing morbidity, hospital stay and early return of patients to regular life.

scholarly journals Results of open tibial fracture treatment using external fixation

2016 ◽  
Vol 144 (5-6) ◽  
pp. 293-299 ◽  
Author(s):  
Ivan Golubovic ◽  
Branko Ristic ◽  
Predrag Stojiljkovic ◽  
Milan Ciric ◽  
Ivana Golubovic ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Motor Vehicle ◽  
Shaft Fracture ◽  
Lower Leg ◽  
Open Fractures ◽  
Type I ◽  
Tibial Shaft Fracture ◽  
Locomotor System ◽  
Pin Tract Infection

Introduction. Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. Objective. The aim of the paper was to present the results of the treatment of 68 patients with open lower leg fractures, as well as the complications that accompany the treatment of these fractures. Methods. In the analyzed group, there were 45 (66.18%) men and 23 (33.82%) women. The majority of patients - 33 (48.53%) of them - were injured in motor vehicle accidents, whereas 24 (35.29%) patients sustained injuries due to falls from heights. In two (2.94%) patients the cause of open tibial fractures was gunshot injuries. In the analyzed group, there were 18 (26.47%) type I open fractures, 21 (30.88%) type II open fractures, 19 (27.94%) type IIIA open fractures, seven (10.29%) type IIIB open fractures, and three (4.41%) type IIIC open fractures. Results. The tibial shaft fracture healed without serious complications in 50 (73.53%) patients, whereas in 18 (26.47%) patients we observed some complications. Nonunion was found in 10 (14.71%) patients, osteitis in four (5.88), malunion in two (2.94%) patients. Milder complications such as soft tissue pin tract infection developed in 13 (19.12%) patients, infection of the open fracture wound soft tissue was observed in four (5.88%) patients. Conclusion. Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies.

scholarly journals Knee Dislocation with Ipsilateral Tibial Fracture Treated with an Intramedullary Locked Nail and Simultaneous Transtibial Tunnel Knee Ligament Reconstruction: A Case Report of Autografts and Limited Resources

2020 ◽  
Vol 06 (03) ◽  
pp. e160-e163
Author(s):  
Túlio Vinícius de Oliveira Campos ◽  
Marcelo Nacif Moraes ◽  
Marco Antônio Percope de Andrade ◽  
Robert C. Schenck ◽  
Simon T. Donell
Keyword(s):  
Ligament Reconstruction ◽  
Tibial Fracture ◽  
Trauma Surgery ◽  
Knee Dislocation ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Knee Ligament ◽  
Knee Ligament Reconstruction ◽  
Ligamentous Reconstruction

AbstractKnee dislocations associated with ipsilateral tibial shaft fracture represent one of the most challenging injuries in trauma surgery. This injury occurs in only 2% of all tibial fractures in several series. With the use of intramedullary nail (IMN) of the tibia, current practice paraments suggest that transtibial tunnels should be avoided and ligamentous knee surgery be delayed until healing of the shaft fracture occurs. We report a novel case which was successfully managed by delayed IMN and multiligamentous transtibial posterior cruciate ligament (PCL) and posterolateral corner (PLC) autograft reconstructions. A 27-year-old male sustained a Gustilo-Anderson grade IIIa tibial shaft fracture and a Schenck IIIL knee dislocation (KD3L) in the ipsilateral knee. At 2 weeks, the patient was then taken back to the operating theater to undergo definitive bone fixation and ipsilateral simultaneous knee ligamentous reconstruction. The knee was stabilized by open reconstruction of the PCL under fluoroscopic control using an ipsilateral quadriceps autograft fixed with metallic interference screws. The PLC was reconstructed with ipsilateral semitendinosus autograft harvested through a separate 1.5-cm standard anteromedial incision using the technique described by Stannard et al. After graft fixation, the 90 degree posterior and posterolateral drawer and 0 and 30 degrees varus stress tests were negative. After 12 months follow-up, the patient had no complaints regarding pain or instability. The tibial fracture had healed and no knee axis deviation could be noted. The patient had returned to recreational low demand activities and motorcycle riding. Treatment of a combined tibial shaft fracture with an ipsilateral knee dislocation may be satisfactorily accomplished with an IMN for the tibia and transtibial tunnel fixation for knee ligament reconstruction allowing for a single rehabilitation course and a shorter recovery without having to use a third stage for knee ligamentous reconstruction.

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