External fixation as an alternative when treating 2nd and 3rd degree open lower leg fractures

Abstract

The infection rate of open lower leg fracture is extremely high. Surgical treatment guarantees a reduced risk of infection when compared with conservative treatments. But even osteosynthetic methods such as screw or compression plate fixation show unsatisfactory results because of the additional traumatization of the primarily injured soft tissue combined with a reduction of blood circulation. From July 1973 till September 1976 we treated 57 2nd and 3rd degree open shank fractures with osteosynthetic methods: 46 with compression plate osteosynthesis and 11 primarily or secondarily with external fixation. The osteitis-rate was 14%, in addition to that there was a soft-tissue infection rate of 5%. In order to change our therapeutical procedure we stabilized 2nd and 3rd degree open lower limb fractures and lower leg fractures complicated by soft-tissue damages consequently by external fixation. From October 1976 till May 1978 we treated 39 open shank fractures; 24 of them were 2nd and 3rd degree open fractures. They were treated by external fixation. This change in our surgical treatment resulted in an osteitis-rate of 2.6%, there was no case of soft-tissue inflammation. These results underline the superiority of treating 2nd and 3rd degree open lower leg fractures and fractures combined with soft-tissue injuries consequently and chiefly with AO external fixation.

Compound fractures of the lower leg: clinical experiences and concept of treatment in multiple injury patients

“…In patients with concomitant injuries, an early arterial DSA should be performed when clinical signs leave any doubt about an arterial injury. In multiple injured patients where laparotomy is essential, external fixation, 7 which generally does not require too much time, should follow immediately and then the arterial DSA should be carried out. When an X‐ray is interpreted as a ‘vaso‐spasm’.…”

Therapie und Prognose schwerer Weichteilverletzungen im Kindesalter

“…Entsprechend der Schwere der Verletzungen nimmt es nicht Wunder, daß postoperativ in nahezu 30% der Fälle eine Infektion der Weichteile und/oder Knochen beobachtet wurde, die jedoch bereits bei Entfernung des Osteosynthesemateriales durchschnittlich nach 4-6 Monaten ausgeheilt war, wie die retrospektive Auswertung der Krankenblattunterlagen zeigte. Eine chronisch posttraumatische Osteitis, wie sie in 5%-10% bei Erwachsenen unseres Krankengutes nach zweit-und drittgradig offenen Frakturen resultierte (7,8), haben wir bei den Kindern nicht beobachtet.…”

“…Eine zu ätzliche Traumatisierung der Weichteile durch Implantate wird bei kritischen Weichteilverhältnissen vor allem durch den Fixateur externe "errnieden (Abb. 2), der nicht zuletzt aufgrund dieses Vorteils in der Behandlung offener Frakturen auch im Kindesalter an Bedeutung gewinnt (6,7).…”