Complications of external fixation of open fractures of the tibia

Clifford, RP; Lyons, Terence J.; Webb, JK

doi:10.1016/0020-1383(87)90130-6

Cited by 58 publications

(27 citation statements)

References 9 publications

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“…If exchange nailing is delayed (more than 3 weeks), the rate of infection rises remarkably (20–45%). If there is established pin tract infection, it may even be as high as 71% 13151831–33. The AO pinless fixator for the tibia has been designed as a stable, temporary, minimally invasive fixator for severe tibial fractures, ensuring safer conversion to an intramedullary nail 30.…”

Section: Discussionmentioning

confidence: 99%

Incidence of infection after early intramedullary nailing of open tibial shaft fractures stabilized with pinless external fixators

Kulshrestha¹

2008

Indian J Orthop

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Background:A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This disadvantage is overcome by the AO pinless fixator, in which the trocar points are clamped onto the outer cortex without penetrating it. This study was designed to evaluate the role of AO pinless fixators in primary stabilization of open diaphyseal tibial fractures that received staged treatment because of delayed presentation or poor general condition. We also analyzed the rate of infection on early conversion to intramedullary nail.Materials and Methods:This study is a retrospective review of 30 open diaphyseal fractures of tibia, which were managed with primary stabilization with pinless fixator and early exchange nailing. Outcome was evaluated in terms of fracture union and rate of residual infection. The data were compared with that available in the literature.Results:All the cases were followed up for a period of 2 years. The study includes Gustilo type 1 (n=10), 14 Gustilo type 2 (n=14), and type3 (n=6) cases. 6 cases (20%) had clamp site infection, 2 cases (6.7%) had deep infection, and in 28 cases (93%) the fracture healed and consolidated well.Conclusion:This study has highlighted the valuable role of pinless external fixator in the management of open tibial fractures in terms of safety and ease of application as well as the advantage of early conversion to intramedullary implant without the risk of deep infection.

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Section: Discussionmentioning

confidence: 99%

Incidence of infection after early intramedullary nailing of open tibial shaft fractures stabilized with pinless external fixators

Kulshrestha¹

2008

Indian J Orthop

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“…10,11 Monolateral external fixation has been employed to treat open tibial fractures with great success; however, not without significant complications. 12,13 Plate fixation has resulted in an unacceptable high infection rate, hence the pursuit of an alternate modality of fracture stabilisation. 14 The recent increase in the use of circular external fixators for open tibial fractures is encouraging especially in high energy injuries but this method has to be individualised on a patient-to-patient basis.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of intramedullary nailing for open fractures of the tibial shaft

Seron¹,

Rasool

2018

SA orthop. j.

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Aim: To establish superficial and deep infection rates and time to union of open tibial shaft fractures treated with primary debridement and locked intramedullary nails. Materials and methods:The clinical records and radiographs were retrospectively reviewed of 74 Gustilo-Anderson grades 1 to 3A open tibial shaft fractures that were treated by initial debridement and intramedullary nail fixation over a two-year period. Sixty-three men and nine women with a mean age of 33 years (range 16-67) were followed up for a mean period of 18 months (range 7-32).Results: Sixteen patients (22%) sustained grade 1 injuries, 38 (51%) grade 2, and 20 (27%) had grade 3A injuries. Thirteen patients (18.1%) were HIV positive. The mean time to surgery was 28 hours (range 8-112). The overall infection rate was 17.6%. Superficial infection developed in 10.8% and deep infection occurred in 6.8%. There was no association between time to surgery and infection rate (p=0.878). There was no association between HIV status and infection (p=0.471). There was no association between type of closure and sepsis (p=0.410). The mean time to union was 17 weeks (range 12-50). Five patients (6.9%) had delayed union and one patient failed to unite without undergoing secondary procedures. Conclusion:The management of Gustilo-Anderson grade 1 to 3A open tibial shaft fractures with primary debridement and locked intramedullary nailing shows good short-term results with low infection and non-union rates despite delay in surgical management or HIV infection. Level of evidence: Level 4Key words: open tibial fractures, intramedullary nails, infection, union

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“…Ce paramètre explique probablement l'absence de corrélation entre le taux de consolidation et le délai de réalisation de l'enclouage de notre série ; • nous avions un faible taux d'ouvertures de type 3 selon la classification de Gustilo (11 %, 6/55 La présence d'une suppuration sur fiche augmente de faç on considérable le risque de complication septique profonde lors de l'enclouage qui peut atteindre 71 % [18][19][20][21][22]. Ce paramètre explique probablement l'absence de corrélation entre le taux de consolidation et le délai de réalisation de l'enclouage de notre série ; • nous avions un faible taux d'ouvertures de type 3 selon la classification de Gustilo (11 %, 6/55 La présence d'une suppuration sur fiche augmente de faç on considérable le risque de complication septique profonde lors de l'enclouage qui peut atteindre 71 % [18][19][20][21][22].…”

Section: Discussionunclassified