External fixation as a primary and definitive treatment for tibial diaphyseal fractures

Beltsios, M.; Savvidou, Olga D.; Kovanis, John; Alexandropoulos, Panagiotis; Papagelopoulos, Panagiotis

doi:10.1007/s11751-009-0062-3

Cited by 53 publications

(53 citation statements)

References 23 publications

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“…80% of cases united without any secondary procedures. In similar study using Ex-fix by Beltsios [11] was 25 weeks In our study 46% cases had knee pain. Most of them had occasional pain only not subsiding even after bony union.…”

Section: Pre Op X-raysupporting

confidence: 65%

Functional outcome of primary unreamed interlocking intramedullary nailing in open tibial fractures

Rajappan¹,

Ravikumar²,

Shamsudeen³

2018

Int. J. Orthop. Sci.

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Background & Objectives: Open tibial fracture management is a major challenge to orthopedic surgeons globally. Successful treatment of open tibial fractures aims at bony union' soft tissue healing and functional improvement to premorbid state. The management protocol for open tibial fracture still remains to be controversial as there is difference in opinion regarding type of implant and method of surgery (reamed or unreamed). Soft tissue injury because of high energy injury and infection makes treatment more challenging. The aim of our study was to evaluate the functional outcome of primary undreamed interlocking intramedullary nailing in open tibial fractures. Materials & Methods: 50 patients presenting to casualty, Govt. Medical College, Kozhikode between Januvary2015-March 2016 with open tibial fractures in the age group 18-60 amenable to ILN was selected. All patients were treated with thorough wound debridement and skeletal stabilization with undreamed interlocking nail in first 24 hours. In all cases, proper soft tissue coverage was attained. Post operatively functionally assessed with modified Johner-Wruhs criteria. Results & Discussion: Majority of the patients was less than 40 years and 94% were males. In 84% of cases mode of injury was Road Traffic Accidents.98% involved middle and distal third fractures.68% of cases were AO group A type and had good outcome.86% cases were type 1&2 open and had good outcome. Average time for bony union was 21.4weeks.There was no case of knee stiffness and ankle stiffness was 4%.46% of cases was associated with anterior knee pain.76% had good outcome and only 6% was associated with poor outcome. There was three case of deep infection, 2 cases of nonunion, 1 case of malunion, 8cases of delayed union, 3cases of shortening and cases of distal screw breakage. Conclusion: Primary undreamed interlocking intramedullary nailing as an ideal method for treatment of open tibial fractures type 1, 2 and 3A. Unreamed nails provide a stable fixation preserving the soft tissues sleeve around the fracture site and maintaining the cortical blood flow. Other potential advantages include shorter operative time, less blood loss, early mobilization, shorter hospital and early weight bearing. Complications like infections malunion, nonunion and implant failure is also less. Intial wound management and soft tissue coverage is of paramount importance in the management of open tibial fractures. The nailing procedure is simple and fast and is easily reproducible by an average surgeon with a short learning curve.

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Section: Pre Op X-raysupporting

confidence: 65%

Functional outcome of primary unreamed interlocking intramedullary nailing in open tibial fractures

Rajappan¹,

Ravikumar²,

Shamsudeen³

2018

Int. J. Orthop. Sci.

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“…16 In our patients,the quality of reduction was very satisfactory as most of the fractures had good reduction and acceptable alignments until bone union.Exercises of joints,range of motion and rehabilitation progress were also encouraged in our protocol.In the second stage of the protocol the temporary external fixator was replaced by locking compression plate osteosynthesis as definitive internal fixator after wound healing of about 28±5days.To avoid intrinsic problems of delayed union,nonunion,pin loosening and pin track infection Rommens et alsugested conversion to internal fixation after soft tissues and all pin sites have healed.The proposed 8 to 12 weeks as ideal time for such conversions. 17 The locking plate provided enough stability without immobilization of the knee and the ankle joint,thus allowing for early rehabilitation to be instituted.The average duration of the hospital stay was about 35±3days.In our study the mean time of union was 24±2weeks(range 12-30weeks).In a study by Beltsios michail et al 18 average time for union of fractures was 25weeks where external fixators were used as primary and definitive treatment for tibial diaphyseal fractures.…”

mentioning

confidence: 42%

Management of Open Fractures of Tibial Diaphysis by External Fixation Followed by Locking compression Plate Osteosynthesis in hemodynamically Unstable Patients: A prospective study

Debbarma¹,

Singh²,

Chishti³

et al. 2016

IOSR

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“…However, other teams have published more promising results. Betsios et al [7], in a series of 220 open and closed tibial fractures, consolidated 87 %. Vijay [8] recorded a success rate of 90 % for open tibial fractures Gustillo grades 3A and 3B.…”

Section: External Fixation As Definitive Treatmentmentioning

confidence: 95%

External fixators and sudden-onset disasters: Médecins Sans Frontières experience

Boillot

Hérard

2014

International Orthopaedics (SICOT)

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Purpose Carrying out osteosynthesis is challenging, and controlling for results and complications is necessary to define the limits of acceptable complications. Within the context of sudden-onset disasters, comparing internal with external osteosynthesis remains controversial. Methods The most recent and significant Médecins Sans Frontières (MSF) experience with osteosynthesis was following the earthquake in Haiti in 2010: 353 external fixators were used in the 12 months following the catastrophe, 62 of which were used in the first month. Carrying out internal osteosynthesis was possible two weeks following the earthquake. Results The most common indication for open tibial fracture was Gustillo grade 2 or 3. Conversion rate from external to internal osteosynthesis remains anecdotal for several practical reasons. Advantages and drawbacks of external fixators are discussed in the context of precarious situations frequently encountered by MSF. Conclusions External osteosynthesis as a primary and definitive treatment for open fractures, especially of the leg, remains the most frequently used and best-adapted procedure in the context of sudden-onset disasters, even though not ideal.

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External fixation as a primary and definitive treatment for tibial diaphyseal fractures

Cited by 53 publications

References 23 publications

Functional outcome of primary unreamed interlocking intramedullary nailing in open tibial fractures

Functional outcome of primary unreamed interlocking intramedullary nailing in open tibial fractures

Management of Open Fractures of Tibial Diaphysis by External Fixation Followed by Locking compression Plate Osteosynthesis in hemodynamically Unstable Patients: A prospective study

External fixators and sudden-onset disasters: Médecins Sans Frontières experience

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