Role of Reamed and Unreamed Interlocking Intermedullary Nailing in the Management of Compound Fracture of Shaft Tibia

2014 ◽  
Vol 23 (Number 2) ◽  
pp. 21-26
Author(s):  
Md. F Ahmed ◽  
Md. M Rahman ◽  
K Dipu ◽  
Md. N Islam
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Deep Infection ◽  
Medullary Canal ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Non Union ◽  
Interlocking Nailing ◽  
Open Injury

Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. The study was done to compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

scholarly journals Comparitive Study of Reamed vs Unreamed Interlocking Intra Medullary Nailing for Fracture Shaft of Tibia

2021 ◽  
pp. 417-422
Author(s):  
N. Mathivanan ◽  
S. V. Satyanarayana
Keyword(s):  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Medullary Canal ◽  
Open Fractures ◽  
Tibial Shaft ◽  
Advantages And Disadvantages ◽  
Interlocking Nailing ◽  
Open Injury ◽  
Radiological Union

Tibia is the commonest bone to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. The aim and objective is a comparative study on the technique, outcome and time taken for clinical and radiological union in either of the reamed or unreamed interlocking nailing in tibial shaft fractures. The operative technique, advantages and disadvantages, follow up, time taken for bony and radiological union and complications if any and overall functional outcome will be evaluated in patients. The follow up of patients will be done in the immediate post operative period and  subsequently  at periodic intervals both clinically and radiologically and the result so obtained will be compared.

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

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.

scholarly journals Results of non-microvascular flap cover surgery for management of soft tissue injury in open fractures of leg bones

2016 ◽  
Vol 15 (10) ◽  
pp. 56-61
Author(s):  
Swayam Prakash Tripathy ◽  
Mohammad Zuber ◽  
Aanand Gautam ◽  
Arun Bhatnagar ◽  
Suneet Tandon ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Open Fractures ◽  
Microvascular Flap ◽  
Flap Cover ◽  
Leg Bones

Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome

2004 ◽  
Vol 86 (11) ◽  
pp. 2569 ◽  
Author(s):  
Keith A. Heier ◽  
Anthony F. Infante ◽  
Arthur K. Walling ◽  
Roy W. Sanders
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Open Fractures

scholarly journals Perioperative management of open fractures in the lower limb

2021 ◽  
pp. 175045892110121
Author(s):  
Bryan Loh ◽  
Jiang An Lim ◽  
Matthew Seah ◽  
Wasim Khan
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Open Fracture ◽  
Wound Care ◽  
Operative Management ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Non Union ◽  
Patient Presentation ◽  
British Orthopaedic Association

An open fracture is a fracture which communicates with the external environment through a wound in the skin. Severe open fractures are managed by both orthopaedic and plastic surgeons to address injuries in both the bone and soft tissue. This review outlines the management of open fractures in the lower limb from the initial patient presentation to operative management (including debridement, skeletal fixation, definitive soft tissue coverage) according to the standards jointly published by the British Orthopaedic Association (BOA) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Additionally, the decision-making between limb salvage or amputation will be explored. Finally, this review will discuss the patient’s postoperative care including wound care and management of potential complications that may arise such as infection, flap failure and fracture non-union.

scholarly journals Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 83-91
Author(s):  
Laveta Stewart ◽  
Faraz Shaikh ◽  
William Bradley ◽  
Dan Lu ◽  
Dana M Blyth ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Tissue Injury ◽  
Hazard Analysis ◽  
Soft Tissue Injury ◽  
Open Fractures ◽  
Severe Injury ◽  
Wound Classification ◽  
Military Patients ◽  
Improvised Explosive

Abstract We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009–2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25–2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and >4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.

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