scholarly journals Open Tibial Fracture in a Non-Compliant Patient: A Case Report

2018 ◽  
Vol 3 (3) ◽  
pp. 44
Author(s):  
Samuele Pizzolo ◽  
Gianluca Testa ◽  
Giacomo Papotto ◽  
Giuseppe Mobilia ◽  
Giovanni Di Stefano ◽  
...  
Keyword(s):  
External Fixation ◽  
Intramedullary Nailing ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Soft Tissues ◽  
Present Report ◽  
Treatment Method ◽  
Tissue Healing ◽  
Compliant Patient ◽  
Diaphyseal Fractures

Open tibial fractures represent the most frequent fractures of long bones, comprising approximately 1.9% of all fractures. Although locked intramedullary nailing is the gold standard for treating closed and unstable tibia diaphyseal fractures, for most exposed fractures, an external fixator can first be used, followed by conversion through an intramedullary nail. The present report describes the case of a 17-year-old male who presented with a complex multi-segmented displaced tibia fracture, type 42-C3, with exposure of IIIB type according to the Gustilo–Anderson classification, and with an attached disrupted fracture of peroneal malleolus, type 44-B2. External fixation was the preferred treatment method. Before the definitive surgical treatment, the patient had a second accident that caused refracture and damage to the soft tissues and external fixation system. This prolonged the time estimated for the conversion from the external fixator to the intramedullary nail. The reported case shows the use of various treatment steps with different timelines and an intervention with vacuum-assisted closure therapy for soft tissue healing as well as subsequent intramedullary nailing in order to reach the definitive healing of a non-compliant patient. These combined methods achieved an acceptable reduction and good stability of such a complex fracture.

scholarly journals Clinical Outcomes in the Definitive Treatment of High-energy Tibial Diaphyseal Fractures using Hexapod External Fixator Versus Monolateral External Fixator

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Kai Liu ◽  
Feiyu Cai ◽  
Xingpeng Zhang ◽  
Hong Li ◽  
...  
Keyword(s):  
External Fixation ◽  
Clinical Outcomes ◽  
External Fixator ◽  
High Energy ◽  
Definitive Treatment ◽  
Fixation Time ◽  
Significant Difference ◽  
Diaphyseal Fractures ◽  
Monolateral External Fixator ◽  
Surgical Duration

Abstract Background: External fixation, which can preserve the biomechanical microenvironment of fracture healing, playing an important role in managing the high-energy fractures with poor surrounding soft tissues. The purpose of this study was to determine the differences of clinical outcomes, if any, between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures.Methods: A total of 53 patients with high-energy tibial diaphyseal fractures and definitively treated by the hexapod external fixator (HEF) or monolateral external fixator (MEF) were retrospectively collected and analyzed, from March 2015 to June 2019. There were 31 patients in the HEF treatment, and the other 22 patients were managed by the MEF. The demographic data, surgical duration, external fixation time, final radiological results, complications, and clinical outcomes were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: The mean surgical duration in the HEF group (62.4±8.3 minutes) was shorter than that in the MEF group (91.4±6.9 minutes) (P<0.05). All patients acquired complete bone union finally. Patients in the HEF group (24.2±3.1 weeks) underwent a shorter average external fixation time than that in the MEF group (26.3±3.8 weeks) (P<0.05). Satisfactory alignment was achieved in all patients without the need for remanipulation. The residual sagittal plane deformities in the HEF group were all less than that in the MEF group (P<0.05). The complication rate was 35.5% in the HEF group, while 45.5% in the MEF group. There was no statistically significant difference between the two groups in ASAMI scores (P>0.05).Conclusion: There is no statistically significant difference in finally clinical outcomes between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. The hexapod external fixation treatment is a superior effective method, including advantages of stable fixation, less surgical duration, postoperatively satisfactory fracture reduction, and fewer complications.

scholarly journals Algorithm for treatment of complex segmental and complex irregular diaphysial fractures of tibia

2020 ◽  
Vol 17 (3) ◽  
pp. 287-300
Author(s):  
A. V. Sialitski ◽  
O. P. Kezlya
Keyword(s):  
Surgical Treatment ◽  
Bone Tissue ◽  
Intramedullary Nailing ◽  
Clinical Experience ◽  
External Fixator ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Postoperative Management ◽  
Ao Classification ◽  
Closed Fractures

In the article, clinical experience of surgical treatment of 239 patients with complex segmental (segmental type C2) and complex irregular (irregular type C3 according to the AO classification) diaphysial fractures of tibia is studied. 215 (89.9 %) patients had Ilizarov’s external fixator and 24 (10.1 %) patients had blocked intramedullary nailing. The article determined the algorithm of preoperative and postoperative management, surgical treatment depending on the nature of bone tissue damage, the size and nature of wounds in open fractures, and the degree of damage to soft tissues in closed fractures.

scholarly journals Hughes External Fixator in Treatment of Tibial Fractures

1985 ◽  
Vol 78 (10) ◽  
pp. 830-837 ◽  
Author(s):  
C M Court-Brown ◽  
S P F Hughes
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Prospective Trial ◽  
Tibial Fractures ◽  
External Fixators ◽  
Complication Rates ◽  
Initial Reduction ◽  
Diaphyseal Fractures ◽  
Grade Ii

The results of a prospective trial of the use of the Hughes unilateral external fixator in the management of 48 tibial diaphyseal fractures are presented. Good results were obtained in grade II and III fractures but not in closed and grade I fractures. The results and complication rates were comparable with those of other more complex external fixators. Good results were found to be dependent on the adequacy of the initial reduction and the duration of external fixation, but independent of alterations in pin angle, length and location as well as fixator location.

scholarly journals Lower limb lengthening over an intramedullary nail: a long-term follow-up study of 28 cases

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Pasquale Farsetti ◽  
Fernando De Maio ◽  
Vito Potenza ◽  
Kristian Efremov ◽  
Martina Marsiolo ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Lower Limb ◽  
Average Length ◽  
Limb Lengthening ◽  
Limb Length ◽  
Tibial Lengthening ◽  
The Mean

Abstract Background Limb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley’s technique, in 28 patients, followed up after a mean period of 8 years. Materials and methods Twenty-eight patients treated for lower limb discrepancy by limb lengthening over an intramedullary nail were reviewed from 5 to 11 years after healing of regenerated bone. There were 20 femurs and 8 tibiae, with average age at surgery of 14.2 years and average length inequality of 6.1 cm for femurs and 5.3 cm for tibiae. Results The mean lengthening was 5.8 cm for femurs and 4.8 cm for tibiae. The mean period of radiographic consolidation of the regenerated bone was 6 months for femoral lengthening and 4.5 months for tibial lengthening. At follow-up, we observed 8 excellent results, 15 good results, 4 fair results, and 1 poor result, based on Paley’s evaluation criteria. The main complications were one deep infection, one nonunion of the distracted segment, one breakage of the distal fiche of the external fixator, and one breakage of both distal locking screws of the intramedullary nail. Discussion We believe that limb lengthening over an intramedullary nail still represents a good method to treat limb length discrepancy because it reduces the time of external fixation, prevents axial deformities and fractures of regenerated bone, and allows early rehabilitation. The new intramedullary lengthening nails, which theoretically are the ideal device for treating limb length inequality, are still very expensive and need longer follow-up for definitive evaluation. Level of evidence 4.

scholarly journals Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

2021 ◽  
Author(s):  
Victor Lu ◽  
James Zhang ◽  
Andrew Zhou ◽  
Matija Krkovic
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Weight Bearing ◽  
Bone Union ◽  
Unique Challenge ◽  
Patient Reported ◽  
Post Traumatic ◽  
Partial Weight ◽  
Consolidation Time

Abstract Purpose The management of limb-length discrepancy secondary to traumatic femoral bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular, but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail. Methods Eight patients were included from October 2015 to May 2019 with post-traumatic femoral defects that underwent treatment with monorail fixator-assisted intramedullary nailing. Primary outcome was time to bone union and bone results according to ASAMI classification. Secondary outcomes were lengthening index, consolidation time and index, external fixator index (EFI), time to partial weight bearing(PWB) and full weight bearing (FWB), and complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores (OKS), and Oxford hip scores (OHS) were recorded after recovery. Results Mean follow-up time was 227 weeks. Average bone defect size was 9.69 cm. Average consolidation time and index were 11.35 months and 1.24 months/cm, respectively. Mean lengthening and external fixator index were 20.2 days/cm and 23.88 days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, five patients had pin site infections, and two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p = 0.104, p = 0.238, respectively). Average OKS was 32.17 and OHS was 34.00. Conclusion Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time and returning patients’ quality of life to a level comparable with the normal population.

scholarly journals Study on the relationship between the timing of conversion from external fixation to internal fixation and infection in the treatment of open fractures of extremities

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zelin Ye ◽  
Shanwen Zhao ◽  
Canjun Zeng ◽  
Ziheng Luo ◽  
Song Yuan ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Soft Tissues ◽  
Open Fractures ◽  
External Fixators ◽  
Type I ◽  
Infection Rates ◽  
Local Conditions ◽  
The Relationship

Abstract Objective To investigate the relationship between the infection rate and the timing of replacement of temporary external fixators with internal fixation, and the timing of immediate or delayed internal fixation after removal of temporary external fixation in the staging treatment modality of open fractures of extremities. Methods A retrospective analysis was performed on 122 cases of open fractures of extremities. External fixators were applied at the early stage and replaced with internal fixation when the condition of soft tissues improved and inflammatory indexes dropped to the normal range or showed a steady downward trend. Depending on the carrying time of external fixators after wound closure or healing, the patients were divided into three groups; the carrying time of groups A, B, and C was ≤ 14 days, 15–28 days, and > 28 days, respectively. Depending on the immediate or delayed internal fixation after removal of external fixator, patients were divided into group a (immediate internal fixation after removal of external fixator) and group b (delayed internal fixation after removal of external fixator, 5–7 days later). Results The infection rates of groups A, B, and C were 6.5%, 5.9%, and 23.3%, respectively. The differences among the three groups were statistically significant (P < 0.05). The infection rates of different Gustilo–Anderson fractures were as follows: no cases of infection out of 10 cases with type I fracture (0%); two cases of infection out of 35 cases with type II fracture (5.7%); three cases of infection out of 36 cases with IIIa fracture (8.3%); five cases of infection out of 28 cases with IIIB fracture (17.9%); and five cases of infection out of 13 cases with IIIC fracture (38.5%). The differences among the five groups were statistically significant. Conclusions The occurrence of infection of open fractures of extremities is associated with the fracture severity (Gustilo classification). For open fractures of Gustilo types I and II, the final internal fixation should be placed as soon as possible when the recovery of general and local conditions is good and the infection is controlled.

scholarly journals Comparative study on intramedullary nailing versus AO external fixation in the management of gustilo type II, IIIA, and IIIB tibial shaft fractures.

2020 ◽  
Vol 27 (06) ◽  
pp. 1199-1205
Author(s):  
Khawand Bukhsh Umrani ◽  
Zamir Hussain Tunio ◽  
Mohammad Aslam Mengal ◽  
Abdul Hafeez Qureshi ◽  
Parvez Ahmed ◽  
...  
Keyword(s):  
Comparative Study ◽  
External Fixation ◽  
External Fixator ◽  
Type Ii ◽  
Tibial Shaft ◽  
Interlocking Nail ◽  
Type Iiia ◽  
Type Iiib ◽  
Diaphyseal Fractures ◽  
Tibial Shaft Fractures

Objectives: To compare the external fixator and unreamed interlocking nail in treating Gustilo type II, type IIIA, and type IIIB tibial diaphyseal fractures regarding complications. Study Design: Cross-Sectional and Comparative Study. Setting: Department of Orthopaedic Surgery and Traumatology (DOST) Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad. Period: Two years February 2016 to January 2018. Material & Methods: 40 cases of open tibia fractures in Patients of Gustilo type II, type IIIA, and type IIIB tibial diaphyseal fractures were included. The data were analyzed using the statistical program SPSS version 16.0. Results: A total of 23 cases were treated by external fixator and 22 cases were treated by unreamed solid interlocking nail. A total of 14 cases, that is, 31% showed delayed union. Type II injury 3/15 = 20%; Type IIIA injury 6/22 = 27.3%; Type IIIB injury it is -5/8 = 12.5%. For cases treated with unreamed nail, it was 22.7%; external fixator was 39.1% among 45 cases, 05 cases showed nonunion. For cases treated with unreamed nail, it was 13.6%; external fixation was 8.7%. The overall rate of eep infection is 11.1%. The rate in interlocking nail was 13.6%, and external fixation was 8.7%. Reoperation in the form of dynamization and bone graft application after 20 weeks in unreamed nail was 36.4%, whereas in external fixation the rate was high, almost 48%. The average time of union with unreamed interlocking was about 25.4 weeks, wherein external fixation it was 28.6 weeks. Conclusion: External fixators are a good and reliable method of stabilization of Gustilo type II, type IIIA, and type IIIB tibial diaphyseal fractures, unreamed interlocking intramedullary nail yields better results in treating Gustilo type II and type IIIA tibial shaft fractures.

Comparison of Clinical Outcomes of Flexible Intramedullary Nailing (FIN) with External Fixation in Pediatric Open Tibial Fractures

2021 ◽  
Vol 15 (11) ◽  
pp. 3455-3457
Author(s):  
Malik M. Yasin Awan ◽  
Mudassar Nazar ◽  
Abdul Qayyum Baig ◽  
Rizwan Anwar ◽  
Muhammad Abdul Hanan ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
External Fixation ◽  
Intramedullary Nailing ◽  
External Fixator ◽  
Group Versus ◽  
Tibial Fractures ◽  
P Value ◽  
Fracture Rate ◽  
Open Tibial Fractures ◽  
Flexible Intramedullary Nailing

Objective: To compare the clinical outcome of flexible intramedullary nailing (FIN) with external fixator in pediatric open tibial fractures. Subjects and Methods: In this randomized comparative study, 80 children having age 5 year to 14 years who presented with open tibial fractures were included. The study was conducted from June-2020 to June-2021 in Islam Hospital Sialkot and Allama Iqbal Memorial Hospital Sialkot. Patients were divided into two equal groups. Group A: underwent external fixation and group B: underwent flexible intramedullary nailing for the surgical management of tibial fractures. Frequency of infections surrounding pins, painful bursitis and re fracture rate within 3 months after surgery was recorded. Results: The mean age of children was 8.42±3.82 years in external fixator group versus 8.40±4.0 years in FIN group (p-value 0.97). Infection-surrounding pins occurred in 9 (22.5%) children were belonging to external fixator group and 01 (2.5%) children was belonging to FIN group (p-value 0.007). Refracture occurred in 6 (15.0%) patients in external fixator group and in no (0.0%) children in FIN group (p-value 0.01). Painful bursitis occurred 2 (5.0%) patient was in external fixator group and in 13 (32.5%) in FIN group (p-value 0.002). Conclusion: Clinical outcome is better in patients treated with FIN as compared to the external fixator for the treatment of pediatric open tibial shaft fractures. Keywords: Flexible intramedullary nails, External fixator, Tibial fractures.

Sign in / Sign up

Export Citation Format

Share Document