scholarly journals Outcome of External Fixator Management of Gustilo Anderson Type III Tibial Fractures in Lagos University Teaching Hospital

2021 ◽  
Vol 3 (2) ◽  
pp. 166-170
Author(s):  
Tochukwu G. Ugwuowo ◽  
Balantine U. Eze ◽  
Benedict A. Okechukwu
Keyword(s):  
Wound Infection ◽  
External Fixator ◽  
Tibial Fracture ◽  
Delayed Union ◽  
Tibial Fractures ◽  
Open Tibial Fracture ◽  
Mechanism Of Injury ◽  
Type Iii ◽  
Associated Injury ◽  
Significant Difference

Type III open tibial fracture is the commonest type of open tibia fracture. The aim of this study was to determine the outcome of Gustilo-Anderson type III open tibial fracture managed with external fixator. Patients that presented with Gustilo-Anderson type III open tibial fractures were recruited. Patients with bone pathology, prior debridement and concomitant spinal cord injury were excluded. Ethical approval and informed consent were obtained. A structured proforma was used to collect the participant’s socio-demographic data, time of injury, fracture location, interval and number of debridement, need for skin graft or flap, duration of hospital stay, outcome of treatment, complications and events at follow-up. Wound biopsy was taken and processed for microscopy, culture, and sensitivity. Delayed union was diagnosed when the fracture united between 4-6 months. Non-union was defined as a varus or valgus angulation of >5 degrees or anterior or posterior angulation of >10 degrees. Patients were followed up for 6 months. Chi square was used to determine association between categorical variables. SPSS 20 was used for analysis. Significance was p value <0.05. Of 35 patients, males were 22 (62.9%) while females were 13 (37.1%) and mean age was 38 years. Average interval between injury and presentation was 14.5 hours. Fourteen (40%) patients had type IIIA, 18 (51.4%) patients had type IIIB while 3 (8.6%) patients had type IIIC. Mean time to fixation was 59.2 hours. Wound infection, malunion, delayed union, pin loosening and compartment syndrome were found in 42.9%, 21.3%, 21.3%, 11.5% and 1.6% respectively. Infection rate was significantly positively correlated with grade of fracture (p=0.04) and time to debridement (p=0.018). A significant association between the mechanism of injury and associated injury (p=0.027) but not mechanism of injury and grade of type III fracture (p=0.292). Significant difference between the duration of hospital stays and categories of type III fractures (p = 0.026) but not associated injury (p=0.403). No significant difference in location of fracture and time of union (p=0.723). Type III fractures managed with external fixator is associated with some complications among which infection is the commonest and delay in treatment is associated with higher risk. Post-debridement microscopy and culture is a better predictor of wound infection.

scholarly journals A PROSPECTIVE ANALYSIS OF GUSTILLO-ANDERSON OPEN TYPE II AND TYPE III TIBIAL DIAPHYSEAL FRACTURES OF AO TYPE 42C1 AND 42C2; THAT WERE SURGICALLY INTERVENED UPON.

2021 ◽  
pp. 1-8
Author(s):  
Umale Rushikesh Hari ◽  
R K Guhan ◽  
Janhavi Thanigaivelu ◽  
Venkatachalam. K
Keyword(s):  
Tibial Fracture ◽  
Tibial Fractures ◽  
Soft Tissue Coverage ◽  
Type Ii ◽  
Open Type ◽  
Type Iii ◽  
Bone Trauma ◽  
Diaphyseal Fractures ◽  
The Mean ◽  
Poor Outcomes

Introduction: Segmental tibial fracture is characterized, as a distinguished kind of fracture type. They are portrayed by at least, two distinctive fracture lines, with a totally separate, inter-calary osseous section, either with intact cortical tubular or as a comminuted segment. AO type 42 C1 and C2 fractures of the tibia are generally, brought about by a high- velocity RTA. They have a high “taux de” of complications. AO type 42 C1 and C2 tibial fractures are considered, as a discrete clinico-surgical bone trauma and are in deep contrast, with the other variants of tibial fractures. Aim: To analyze the functional outcome of Gustillo- Anderson open type II and type III Tibial Diaphyseal fractures of AO Type 42C1 and 42C2; that were surgically intervened upon. Materials and Methods: 62 adult patients in the age bracket of 26-55 years having Gustillo-Anderson open type II and type III Tibial Diaphyseal fractures of AO Type 42C1 and 42C2, were surgically intervened in the form of reamed IMIL nailing. Results: We achieved 62.36% Excellent, 13.98% Good, 15.05% Fair and 4.84% Poor outcomes calculated by the mean of mean scores of Johner AND Wruhs Criteria, Modified Knee Society Score, Yokoyama Criteria scores. Conclusion: This study concludes that Gustillo- Anderson open type II and type III Tibial Diaphyseal fractures of AO Type 42C1 and 42C2 can be managed satisfactorily with IMIL nailing without the need of external fixator application, provided appropriate soft tissue coverage is given at the appropriate time.

Comparison between External Locking Plate Fixation and Conventional External Fixation for Extraarticular Proximal Tibial Fractures: A Finite Element Analysis

2021 ◽  
Author(s):  
Dejan Blažević ◽  
Janoš Kodvanj ◽  
Petra Adamović ◽  
Dinko Vidović ◽  
Zlatko Trobonjača ◽  
...  
Keyword(s):  
Finite Element ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fracture ◽  
Locking Plate ◽  
Plate Fixation ◽  
Tibial Fractures ◽  
Proximal Tibial Fracture ◽  
Locking Plate Fixation ◽  
Maximum Stiffness

Abstract BackgroundGood clinical outcomes for locking plates as an external fixator to treat tibial fractures have been reported. However, external locking plate fixation is still generally rarely performed. This study aimed to compare the stability of external locking plate fixator with that of conventional external fixator for extraarticular proximal tibial fractures, using finite element analysis. MethodsThree models were constructed: (1) external locking plating of proximal tibial fracture with lateral proximal tibial locking plate and 5-mm screws (ELP), (2) conventional external fixation of proximal tibial fracture with an 11-mm rod and 5-mm Schanz screws (EF-11), and (3) conventional external fixation of proximal tibial fracture with a 7-mm rod and 5-mm Schanz screws (EF-7). The stress distribution, displacement at the fracture gap, and stiffness of the three finite element models at 30-, 40-, 50-, and 60-mm plate–rod offset from the lateral surface of the lateral condyle of the tibia were determined. ResultsThe conventional external fixator showed higher stiffness than did the external locking plate fixator. In all models, the stiffness decreased as the distance of the plate–rod from the bone surface increased. The maximum stiffness was 121.06 N/mm in the EF-11 model with 30-mm tibia–rod offset. In the EF-7 model group, the maximum stiffness was 40.00 N/mm in the model with 30-mm tibia–rod offset. In the ELP model group, the maximum stiffness was 35.79 N/mm in the model with 30-mm tibia–plate offsetConclusionsExternal locking plate fixation is more flexible than conventional external fixation, which can influence secondary bone healing. External locking plate fixation requires the placement of the plate as close as possible to the skin, which allow low-profile design, because the increased distance of the plate from bone can be too flexible for bone healing.

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.

Metaphyseal locking plate as an external fixator for open tibial fracture: Clinical outcomes and biomechanical assessment

Injury ◽  
2017 ◽  
Vol 48 (2) ◽  
pp. 501-505 ◽  
Author(s):  
Ching-Hou Ma ◽  
Chin-Hsien Wu ◽  
Jiun-Ru Jiang ◽  
Yuan-Kun Tu ◽  
Ting-Sheng Lin
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Tibial Fracture ◽  
Locking Plate ◽  
Open Tibial Fracture ◽  
Biomechanical Assessment

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 Incidence and Predictive Factors of Tibial Fracture with Occult Posterior Ankle Fractures

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Dafeng Wang ◽  
Jie Yang ◽  
Xiaomin Dong ◽  
Shengtuo Zhou ◽  
Chaonan Wang
Keyword(s):  
Regression Analysis ◽  
Predictive Factors ◽  
Ankle Fracture ◽  
Tibial Fracture ◽  
Tibial Fractures ◽  
Ankle Fractures ◽  
Imaging Data ◽  
Fracture Group ◽  
Posterior Malleolus ◽  
Significant Difference

Background. Few studies exist on the predictive factors of tibial fractures with hidden posterior ankle fractures. Objective. To study the incidence and predictive factors of tibial fractures with occult posterior ankle fractures. Methods. Tibial fracture patients were prospectively selected who were admitted to our hospital from January 2016 to May 2021 and their general clinical data, X-ray images, CT images, and other imaging data were collected and then divided them into posterior malleolus fracture group and nonposterior malleolus fracture group according to the presence or absence of posterior malleolus fractures. Multivariate regression analysis and receiver operating curves (ROC) were performed to analyze the influencing factors of tibial fracture with occult posterior ankle fracture. Results. CT showed that 25 (13.44%) patients had occult posterior ankle fractures among 186 patients with tibial fracture. There was no significant difference in gender, age, and locations of tibial fracture between the two groups ( P > 0.05 ). There were statistical differences in the types, locations, and lengths of patients with tibial fracture but without posterior malleolus fractures. The length of the tibia fracture group was significantly lower than the tibia with posterior ankle fracture group ( P < 0.05 ). Logistics regression analysis showed that tibial fracture with occult posterior ankle fracture was not significantly correlated with gender, age, and location of tibial fracture ( P > 0.05 ), but was significantly correlated with tibial fracture type, location, and length (HR = 1.830, P = 0.035 ; HR = 5.161, P = 0.004 ; HR = 1.126, P = 0.030 ). The ROC curve showed that the AUC of length of tibial fracture with occult posterior ankle fracture was 0.599. The YD index suggested that the best cut point for the prediction of tibial fracture with occult posterior ankle fracture was above 13.18%. The sensitivity and specificity of spiral tibial fracture and distal 1/3 tibial fracture for prediction were 88.00% and 63.35%, 92.00%, and 58.39%, respectively, which was significantly higher than that of tibial fracture length ( P < 0.05 ). Conclusion. Patients with tibial fractures have a higher incidence of occult posterior ankle fractures. Spiral tibial fractures and distal 1/3 tibial fractures have a higher predictive value for tibial fracture with occult posterior ankle fractures and can help clinical detection as soon as possible, which is a more accurate and appropriate treatment.

scholarly journals Treatment of Open Tibial Fracture by Ilizarov External Fixator versus Unreamed Interlocking Nail

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M M H Fayed ◽  
M A Alkersh ◽  
A E Eldesouky
Keyword(s):  
Clinical Outcome ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fracture ◽  
Open Fractures ◽  
Open Tibial Fracture ◽  
Tibial Shaft ◽  
Ilizarov External Fixator ◽  
Interlocking Nail ◽  
Tibial Shaft Fractures

Abstract The objective of this study is to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov external fixation (IEF) for the treatment of open fractures of the tibia. Patients with open tibial shaft fractures were treated with an IEF or UTN. Both groups were compared for union time, nonunion, infections, mechanical failure of the implant, and malunion. We searched numerous sources and eventually included studies, totaling participants.

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