Acute Septic Arthritis Following Supra-Patellar Nailing of an Open Diaphyseal Tibia Fracture in an Immune Compromised Patient

The supra-patellar approach represents one approach to intramedullary nailing (IMN) of diaphyseal tibia fractures. Violation of the knee joint utilizing an intra-articular start point represents a risk for septic arthritis of the knee in the post-operative period. Previous retrospective studies of open tibia and femur fractures demonstrated that post-operative knee sepsis is rare, occurs in the chronic phase after injury, and due to extent of soft tissue injury rather than immune compromise. Here, we review current literature on post-operative knee sepsis, and present a case of acute septic arthritis of the knee following supra-patellar nailing of an open tibia fracture in a patient on chronic immune suppression. In this unique case, co-morbid patient factors likely led to this manifestation of a rare complication.

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Management of soft tissue injury in the open tibia fractures

Surgical Update: International Journal of Surgery and Orthopedics ◽

10.17511/ijoso.2019.i04.09 ◽

2019 ◽

Vol 5 (4) ◽

pp. 288-292

Author(s):

Dr. Pragnesh Patel ◽

◽

Dr. Vimal P. Gandhi ◽

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Tibia Fractures

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Prospective Evaluation of Role of Limb Reconstruction System (Rail External Fixator) in Open Fractures and Infected Non-union of Femur

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i01.1942 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hemant Singh Chahar ◽

Mayur Gupta ◽

Vinod Kumar ◽

Rohit Yadav ◽

Jaydeep Patel ◽

...

Keyword(s):

Tissue Injury ◽

Soft Tissue Injury ◽

Case Series ◽

Functional Results ◽

Open Fractures ◽

Long Bone ◽

Limb Reconstruction ◽

Non Union ◽

Femur Fractures

Introduction: Severe open fractures continue to be a nightmare for orthopedicians even with use of more accepted line of treatment. Open fractures and infected non-union of femur bone are not infrequently seen in orthopedic wards as femur is the most common long bone injured. We present a case series of 14 such patients treated successfully with limb reconstruction system enabling recovery to pre-injury status and activities. Case Series: The present study was done to access the role of limb reconstruction system in the management of open femur fractures and in infected non-union with modifications to meet the requirements of each case. We viewed the results of treatment of 14 cases of late presentation with complicated open femur fractures and infected non-unions. Average time of fixator removal was 4 months–24 months. Average follow-up duration was 18 months (range 6?36 months). Evaluation of results was based on ASAMI criteria. The excellent bone results were obtained in 85.72% of cases while 7.14% showed good and 7.14% were poor results. Excellent functional results were observed in 71.43% of cases and 28.57% of cases shows good and fair results. Conclusion: The use of limb reconstruction system is based on compression and distraction technique. It was found to be a simple and effective modality for open injuries in terms of enhanced union rate, rapid rehabilitation, and easy care of soft-tissue injury along with bone loss, thus avoiding multiple surgeries. Keywords: Open fracture, non-union, femur, limb reconstruction system, ASAMI criteria.

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Management of Fractures of Distal third Tibia by Interlock Nailing

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1043 ◽

2016 ◽

Vol 3 (1) ◽

pp. 15-22

Keyword(s):

Tissue Injury ◽

Distal Tibia ◽

Soft Tissue Injury ◽

Skin Condition ◽

Delayed Union ◽

Fracture Site ◽

Tibia Fracture ◽

Asia Pacific ◽

Fracture Geometry ◽

Fibula Fracture

ABSTRACT Introduction Most of the distal third tibia is subcutaneous and has precarious blood supply. Fractures of the distal third tibia have comminution at the fracture site, as it is metaphyseal cancellous bone with a thin shell of cortex, and have associated significant soft tissue injury. Generally, skin condition is not satisfactory due to ecchymosis, blebs, swellings, wounds, etc. All these factors contribute to delayed union, nonunion, and malunion. The present study is about the ability to maintain a mechanically stable reduction in the distal third tibia with intramedullary nail, when lower 4 cm of tibia not fractured. If associated with fibula fracture (in lower 10 cm), it is always fixed as a rule to give stability to syndesmosis and stability to same-level tibia fracture. Materials and methods From January 2013 to March 2015, 60 patients of distal tibia fracture admitted to Government Medical College and Hospital, Latur, were operated and followed up prospectively. Results Mean age of patients was 35 years (25–50). Fracture union was seen radiologically within 3 to 4 months, depending on fracture geometry. Conclusion We conclude that results of fractures of distal third tibia not extending into lower 4 cm of tibia treated with interlock nailing were found satisfactory. Meticulous planning and placement of nail at the center of a wide metaphysis in the anteroposterior and lateral is mandatory to avoid varus, valgus, and posterior tilt. Polar screw or temporary K-wire during surgery is very helpful. Same-level fibula fracture fixation with a plate or square nail is very effective for stability of reduction. How to cite this article Gawali SR, Kukale SB, Nirvane PV, Toshniwal RO. Management of Fractures of Distal third Tibia by Interlock Nailing. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):15-22.

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A STUDY ON OUTCOME OF SURGICAL TREATMENT OF COMPOUND TIBIA FRACTURES BY INTRAMEDULLARY NAILING AFTER PRELIMINARY EXTERNAL FIXATION – SHORT TERM RETROSPECTIVE AND PROSPECTIVE ANALYSIS

10.36106/ijsr/6800989 ◽

2021 ◽

pp. 19-21

Author(s):

Suresh Kumar Thirugnanam ◽

Sudhakar Ramasamy

Keyword(s):

Surgical Treatment ◽

Functional Outcome ◽

Intramedullary Nailing ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Prospective Analysis ◽

Short Term ◽

Tibia Fractures ◽

Grade Iii

About 23% of all tibial fractures are open and most of these are Gustilo grade III. This study was done to evaluate the functional outcome of surgical treatment of compound tibia fractures by intramedullary nailing after preliminary external xation as a short term retrospective and prospective analysis. From February 2012 to November 2013, a short term retrospective and prospective analysis was done in The Institute of Orthopedics & Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. We did secondary interlocking nailing after preliminary external xation for grade II to grade III B open tibia fractures in 31 patients for 31 fractures (Box 1 shows the inclusion and exclusion criteria). Out of these 31 patients, we lost follow-up of 4 patients and analyzed the results with the average follow-up of 12 months and minimum follow up of 5 months. Data was tabulated and analysed using Microsoft excel 2003. Functional outcome of secondary intra medullary nailing after external xation was far better than in primary interlocking with primary closure in our institution. Although the supercial infection is there and there is delay in denitive procedure in the management of compound fractures, this can be improved by early surgical intervention, timely secondary procedures and accurate assessment of soft tissue injury. The nal outcome is mainly depends on the age of the patient, time of admission since injury, type of injury.

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Role of closed intramedullary interlocking nailing in comminuted fractures of long bones in lower limbs

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173995 ◽

2017 ◽

Vol 5 (9) ◽

pp. 4122

Author(s):

Sanjeev Sreen ◽

Manjit S. Daroch ◽

Deepak Vashisht ◽

Nitish Kapil

Keyword(s):

Blood Supply ◽

Femur Fracture ◽

Average Duration ◽

Tibia Fracture ◽

Lower Limbs ◽

Long Bones ◽

Interlocking Nailing ◽

Femur Fractures ◽

Tibia Fractures ◽

Comminuted Fractures

Background: Fractures are the most common form of skeletal injuries encountered in orthopaedic practice. Increase in mechanization and high-speed travel are accompanied by increase in the number and severity of the fracture. Our ultimate goal of femur and tibia fracture management is restoration of alignment, rotation and length, preservation of blood supply to aid union, prevention of infection and early rehabilitation of the patient.Methods: 30 adult patients of either sex with 30 comminuted fractures of long bones were treated with closed intramedullary interlocking nail. AO type B3 and C in femur and tibia are included. There were 25 males and 5 females, and average age of patients was 36.2 years. Out of 30 cases, 13 cases were of femur fracture while 17 cases were of tibia fracture. There were 21 closed and 9 patients had Grade I open fractures.Results: Closed intramedullary interlocking nailing was done in 13 cases of femur fracture and 17 cases of tibia fracture. The average duration of partial weight bearing in femur fractures was 4.85 weeks and in tibia fractures was 5.53 weeks. 20 fractures united without additional intervention. The average duration of radiological union in femur fractures was 18.65 weeks and for tibia fractures was 19.29 weeks.Conclusions: Closed intramedullary interlocking nailing is the treatment of choice of comminuted fractures of long bones in lower limbs which cause minimum damage to the blood supply of the fracture fragments which promotes the chances of bone union.

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Minimally Invasive, Non-Terminal In Vivo Muscle Testing of a Porcine Tibia Fracture Model

Proceedings of IMPRS ◽

10.18060/22744 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Alexander W. Peters ◽

Benjamin T. Corona ◽

Anthony J. Milto ◽

Aamir Tucker ◽

Alex Brinker ◽

...

Keyword(s):

Tissue Injury ◽

Soft Tissue Injury ◽

Strength Loss ◽

Tibia Fracture ◽

Fracture Model ◽

Post Injury ◽

Initial Strength ◽

Muscle Testing ◽

Tibia Defect

Background and Hypothesis: Soft tissue injury surrounding tibia fractures is a key determinant of surgical care decisions and healing outcomes. We have established a porcine tibia fracture model with a corresponding volumetric muscle loss (VML) injury in the adjacent peroneus tertius (PT) muscle. Herein, we test the hypothesis that tibia fracture without VML induces an initial strength deficit that recovers within three months post-injury, while VML injuries present chronic strength deficits. Experimental Design or Project Methods: 15 castrated Yucatan minipigs pigs will be evaluated in the following groups: Tibia defect (TD)-only, TD+small VML, and TD+large VML. To date, 12 have undergone injury, and 3 have completed the study (TD-only, n=2; TD+small VML, n=1). In vivo muscle testing of the anterior compartment of the lower hindlimb was performed before and 1, 2, and 3 months post-injury. Results: Before injury the non-operative and operative limbs had similar peak muscle strength (11.8±1.0 vs. 10.8±0.6 Nm; p=0.42), and non-operative limb strength did not change during the study (ANOVA p=.89). Relative to pre-injury values, the tibia defect with VML injury presented 71, 77, and 79% strength loss, while the tibia defect-only limbs presented 46, 60, and 48% strength loss at 1, 2, and 3 months post-injury, respectively. Conclusion and Potential Impact: The data are limited by low sample sizes as this project is ongoing. Preliminary data do not appear to support the hypothesis, as limbs with TD-only presented persistent strength deficits, though potentially of lesser magnitude than VML injured limbs. The mechanism of strength loss following TD-only may be related to disuse.

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Diagnosis: Chronic Phase of Soft-Tissue Injury to the Cervical Spine

Musculoskeletal Manual Medicine ◽

10.1055/b-0034-72445 ◽

2008 ◽

Keyword(s):

Cervical Spine ◽

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Chronic Phase

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Minimally invasive plate osteosynthesis of lower end of femur fractures using locking compression plating: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173939 ◽

2017 ◽

Vol 3 (5) ◽

pp. 1043 ◽

Cited By ~ 1

Author(s):

Raghu Kumar J. ◽

Prasanna Anaberu ◽

Vinit M. Oswal

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Closed Reduction ◽

Distal Femur ◽

Tissue Injury ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Minimally Invasive Plate Osteosynthesis ◽

Femur Fractures

Background: The treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Pre-contoured Locking compression plates (LCPs) have shown to give best results in terms of recovery, fracture union, return to work and functional outcome. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections.The objective was to study the functional result of fracture distal femur treated by closed reduction with LCP by minimally invasive plate osteosynthesis (MIPO).Methods: 20 cases of fracture distal end of femur were treated by closed reduction and internal fixation using LCP by MIPO between 1st October 2013 to 30th September 2015 at our centre. The patients were evaluated clinically and radiologically for functional outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’s score.Results: 8 of my patients were male and 12 were female. All of them were closed injuries and fresh cases. The mean age was 51.8 years (21-68 yrs). 13 patients sustained RTA and 7 patients had accidental fall. 8 patients had right sided distal femur fracture and 12 had left sided injury. According to NEER’s score 50% had excellent results, 35% had good results and 15% had fair results. Gait and weight bearing after union was satisfactory. Range of motion of knee joint in majority of patients was within acceptable limits. Conclusions: Closed reduction and internal fixation of fracture lower end of femur by MIPO using LCP is one of the best modalities of treatment for good results.

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A prospective study of management of subtrochanteric femur fracture using proximal femoral nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200739 ◽

2020 ◽

Vol 6 (2) ◽

pp. 292

Author(s):

Shwetabh Malik ◽

Parimal Malviya ◽

Alfven Vieira ◽

Deepak Jain

Keyword(s):

Proximal Femur ◽

Femur Fracture ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Medullary Canal ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Subtrochanteric Fractures ◽

Femur Fractures ◽

Femoral Nail

Background: Proximal femur fractures present considerable challenge in management. They are due to high velocity trauma, with or without soft tissue injury and usually with a metaphyseal and diaphyseal involvement. The surgeon has to face many challenges like identifying the entry, reduction the fracture, and difficulty due to a narrow medullary canal and comminution. The present study was conducted to assess the utility and effectiveness of Proximal Femoral Nail for subtrochanteric fractures of femur.Methods: In this study a total of 30 patients with Sub trochanteric femur fracture admitted to MGM medical college and hospital from June 2015 to July 2017 were selected for treatment with proximal femur nail.Results: 30 patients were included in this study with subtrochanteric fractures of femur treated with Proximal femoral nail. Maximum 21(70%) of patients were below 61 yrs of age. Mean age was 47.9 years. There was 21 male and 9 females in the study. There were 6 patients with local complications. Final result of our study, we had 26.7% excellent, 46.6% good, 20% fair and 6.7 % poor results according to Harris hip score.Conclusions: In our study, looking at the results we found that Proximal femoral Nail proves to be a good implant in management of subtrochanteric fractures of femur. However, it is a small study to conclude anything definitely.

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Surgical Treatment of Posttraumatic Radioulnar Synostosis

Case Reports in Orthopedics ◽

10.1155/2016/5956304 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

S. Pfanner ◽

P. Bigazzi ◽

C. Casini ◽

C. De Angelis ◽

M. Ceruso

Keyword(s):

Surgical Treatment ◽

Functional Disability ◽

Tissue Injury ◽

Biceps Tendon ◽

Rare Complication ◽

Formation Rate ◽

Soft Tissue Injury ◽

High Energy ◽

Inert Material ◽

Radioulnar Synostosis

Radioulnar synostosis is a rare complication of forearm fractures. The formation of a bony bridge induces functional disability due to limitation of the pronosupination. Although the etiology of posttraumatic synostosis is unknown, it seems that the incidence is higher in patients who have suffered a concomitant neurological or burn trauma, and extensive soft tissue injury, mainly due to high-energy impact. Surgical treatment, such as reinsertion of distal biceps tendon into the radius, seems to be another possible factor. The aim of the surgical treatment is to remove the bony bridge and restore complete range of movement (ROM), thus preventing recurrence. Literature does not indicate a preferred type of surgical procedure for the aforementioned complication; however, it has been shown that surgical interposition of inert material reduces the formation rate of recurrent bony bridge. We describe a surgical technique in two cases in which the radius and ulna were wrapped with allogenic, cadaver fascia lata graft to prevent bony bridge formation. The data from 2 years of follow-up are reported, indicating full restoration of ROM and no recurrence of synostosis.

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