Dilution of Open Fracture Grade IIIA of the Lower Leg Using Normal Saline 0.9% Mixed with Honey Compared With Normal Saline 0.9% to the Bacterial Growth

Aims: To determine the effectiveness of 3, 6, and 9 liters of physiological saline for wound irrigation in grade II open fracture at lower extremity in reducing the number of bacterial colonies Study Design: This observational study determined the quantity of physiological saline for wound irrigation in grade II open fracture at lower extremity which is effective in reducing the number of bacterial colonies. Place of Study: Moewardi Hospital Emergency Room and the Microbiology Laboratory of the Faculty of Medicine, Universitas Sebelas Maret. Methodology: 16 patients with grade II open fracture at lower extremity who came and received treatment was included. Patients with grade II long bone open fracture less than six hours, patients with multiple open fractures of the long bones taken only in one place, patients who had not received medical treatment since the incident were included. Patients suffering from previous bone and/or soft tissue infections at the fracture site and suffering from multiple trauma who should receive immediate life-saving measures were included. Results: There were 12 patients who met criteria inclusion. After 3 L irrigation, there was a decrease in the amount of bacterial colony, same as 6 L irrigation, while there was no increase in the number of bacterial colonies in 9 L irrigation. There were significant differences in 3L, 6L, 9L irrigations (p = 0.001), but the most effective irrigation fluid was in 9 liters compared with 6 liters (p <0.05). Conclusion: Wound irrigation with 3, 6, and 9 liters of normal saline will significantly reduce the number of bacteria. However, irrigation with 9 liters of normal saline dilution in grade II open fracture at the lower extremity is the most effective.

Download Full-text

Lower Leg Severe Open Fracture Caused by Traffic Accident - Treatment by External Skeletal Fixation: Case Report

Acta Facultatis Medicae Naissensis ◽

10.2478/v10283-012-0014-6 ◽

2012 ◽

Vol 29 (2) ◽

Author(s):

Ivan Golubović ◽

Goran Stevanović ◽

Predrag Stojiljković ◽

Zoran Golubović ◽

Danilo Stojiljković ◽

...

Keyword(s):

Case Report ◽

Traffic Accident ◽

Open Fracture ◽

Lower Leg

Download Full-text

Rhabdomyosarcoma of Right Lower Leg Resulted from Open Fracture. Report of A Case

Orthopedics & Traumatology ◽

10.5035/nishiseisai.25.140 ◽

1976 ◽

Vol 25 (2) ◽

pp. 140-143

Author(s):

Y. Taniguchi ◽

N. Baba ◽

T. Niimura ◽

N. Higashi ◽

K. Masuzaki ◽

...

Keyword(s):

Open Fracture ◽

Lower Leg

Download Full-text

Wound Irrigation Pressure Did Not Affect Reoperation Rate After Open Fracture Repair, but Normal Saline Solution Was Better Than Castile Soap

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.16.00210 ◽

2016 ◽

Vol 98 (10) ◽

pp. 871

Author(s):

Patrick Schottel

Keyword(s):

Normal Saline ◽

Open Fracture ◽

Saline Solution ◽

Reoperation Rate ◽

Fracture Repair ◽

Wound Irrigation ◽

Castile Soap ◽

Better Than

Download Full-text

Surgical treatment of the lower leg open fracture with lesions of the main blood vessels. A case report

Vojnosanitetski pregled ◽

10.2298/vsp160613343s ◽

2018 ◽

Vol 75 (4) ◽

pp. 422-427

Author(s):

Predrag Stojiljkovic ◽

Milan Jovanovic ◽

Ivan Golubovic ◽

Zoran Radovanovic ◽

Goran Stevanovic ◽

...

Keyword(s):

Case Report ◽

Soft Tissue ◽

Blood Vessels ◽

Open Fracture ◽

Lower Leg ◽

Open Fractures ◽

Acute Ischemia ◽

Anterior Tibial Artery ◽

Angular Deformity ◽

X Ray

Introduction. Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work.

Download Full-text

Results of open tibial fracture treatment using external fixation

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1606293g ◽

2016 ◽

Vol 144 (5-6) ◽

pp. 293-299 ◽

Cited By ~ 2

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.

Download Full-text

Accelerated Lower Leg Fracture Healing in Traumatic Brain Injury in Accordance With Increased Hematoma Formation

10.21203/rs.3.rs-948393/v1 ◽

2021 ◽

Author(s):

Dong Woo Shim ◽

Hyunjoo Hong ◽

Kwang-Chun Cho ◽

Se Hwa Kim ◽

Jin Woo Lee ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Fracture Healing ◽

Bone Healing ◽

Open Fracture ◽

Callus Formation ◽

Lower Leg ◽

Hematoma Formation ◽

Lower Leg Fracture ◽

Group 1

Abstract BackgroundTraumatic brain injury (TBI) has been known to accelerate bone healing. Many cells and molecules have been investigated but the exact mechanism is still unknown. We aimed to investigate the effect of TBI on fracture healing regarding accelerated hematoma formation.MethodsWe retrospectively investigated patients who were surgically treated for lower leg fractures and who showed secondary bone healing. Patients with and without TBI were divided for comparative analyses. Radiological parameters were time to bridging callus formation and the largest callus ratio during follow-up. Preoperative levels of complete blood count and chemical battery within 3 days from trauma were measured in all patients. Subgroup division regarding age, gender, open fracture, concomitant fracture and severity of TBI were compared.ResultsWe included 48 patients with a mean age of 44.9 (range, 17 – 78), of whom 35 patients (72.9%) were male. There were 12 patients with TBI (Group 1) and 36 patients without TBI (Group 2). Group 1 showed shorter time to callus formation (P < 0.001), thicker callus ratio (P = 0.015), leukocytosis and lymphocytosis (P ≤ 0.028), and lower red blood cell counts (RBCs), hemoglobin, and hematocrit (P < 0.001). Aging and severity of TBI were correlated with time to callus formation and callus ratio (P ≤ 0.003) while gender, open fracture, and concomitant fracture were unremarkable.ConclusionLower leg fractures with TBI showed accelerated bone healing and superior measurements associated with hematoma formation (lymphocytes, RBCs, hemoglobin, hematocrit). Promoted fracture healing in TBI was correlated with the enhanced proinflammatory state.Level of Evidence: Case control study; III

Download Full-text

Venous Supercharging Reduces Complications and Improves Outcomes of Distally Based Sural Flaps

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1598620 ◽

2017 ◽

Vol 33 (05) ◽

pp. 343-351 ◽

Cited By ~ 15

Author(s):

Farid Bekara ◽

Nicolas Bertheuil ◽

Raphael Carloni ◽

Sandy Dast ◽

Raphael Sinna ◽

...

Keyword(s):

Comparative Study ◽

Open Fracture ◽

Lower Leg ◽

Venous Congestion ◽

Width Ratio ◽

Significant Difference ◽

Distal Lower Leg ◽

Length Width ◽

Prospective Comparative Study ◽

Distally Based

Background The use of distally based neurocutaneous sural flaps (DBNCSF) is one of the most common methods of reconstructing the distal lower leg. However, they have developed a bad reputation because of their propensity for venous engorgement. Venous congestion that can lead to distal necrosis can be prevented by venous supercharging. Using a prospective comparative study, we thus explored the effect of venous supercharging on the reliability of these useful workhorse flaps. Methods We prospectively included 38 patients who received a conventional DBNCSF and 38 patients who received a supercharged version of this flap (sDBNCSF) between January 2012 and July 2016. Results No significant difference was identified between the groups in terms of age, sex, comorbidity, or defect origin. The main reconstruction etiology was traumatic (open fracture, scar disunion, and chronic osteitis). The flap size was noticeably larger in the sDBNCSF group, albeit without significance. The length-width ratio was significantly greater in the sDBNCSF group (6.08 vs. 5.53, p = 0.022). Venous congestion was significantly more common in the non-supercharged group (28.6 vs. 2.6%, p = 0.01), as was coverage failure (23.7 vs. 2.6%, p = 0.035). Conclusion There are significant benefits to using venous supercharging of DBNCSF, when technically feasible. In our experience, venous supercharging increases reliability, allows the raise of larger skin paddles with much narrower pedicles limiting the morbidity of the procedure, and improves the functional and esthetic results.

Download Full-text