Grade 3 open tibial shaft fractures treated with a circular frame, functional outcome and systematic review of literature

Dickson, Danelle; Moulder, Elizabeth; Hadland, Y; Giannoudis, Peter V.; Sharma, Hemant

doi:10.1016/j.injury.2015.01.025

Cited by 53 publications

(84 citation statements)

References 78 publications

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“…Early administration of antibiotics, 4 adequate debridement 39 and early wound cover 40 They reported deep infection rates of 0.9% in 420 patients treated in circular fixators, compared with 11% in 492 patients treated with plate fixation, 10.7% in 625 patients treated with mono-lateral external fixators, 8.7% in 547 patients treated with reamed nailing, and 7.1% in 1 223 patients who were treated with unreamed nails. 41 The difference in deep infection rates between circular fixators and these other fixation methods was found to be statistically significant. (p < 0.001) Deep infection occurred in 4.25% of cases in our series and compares favourably to the published results of other treatment modalities.…”

Section: Discussionmentioning

confidence: 92%

Short-term results of grade III open tibia fractures treated with circular fixators

2016

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Grade III open tibia fractures have previously been shown to have high infection and non-union rates, and the optimal treatment remains controversial. We present the short-term results of 94 consecutive Gustilo-Anderson grade III open tibia fractures, definitively treated with circular external fixators in this retrospective study. A total of 94 patients (80 males and 14 females), with a mean age of 36.5 years (range 8-73) were followed up for a mean period of 12 months (range 6-52). Deep infection occurred in four patients (4.3%) and non-union in three patients (3.2%). The mean time to union was 23 weeks (range 11-79). The prevalence of HIV infection was 32.9% and no statistically significant association between HIV infection and an increased risk of deep infection (p = 0.601) or nonunion (p = 0.577) could be demonstrated. Pin-site infection occurred in 16% with the majority being low-grade infections. The management of grade III open tibia fractures with definitive circular external fixation delivered promising short-term results with low complication rates in terms of infection and non-union.

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Section: Discussionmentioning

confidence: 92%

Short-term results of grade III open tibia fractures treated with circular fixators

2016

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“…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. 15,16 The efficacy of intramedullary nails in the acute management of open tibial fractures is contentious. 17,18 The fear of osteomyelitis has previously precluded any form of internal fixation especially in the immune-compromised host and delays in operative management greater than six hours.…”

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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“…The time to achieve union with Ilizarov fixator varies in different studies since different authors have used different criteria for assessment of union. Inan et al reported bony union in 19 weeks in all type III-A fractures [33] . The average time of union in our study was 16 weeks.…”

Section: Discussionmentioning

confidence: 98%

Role of Ilizarov ring fixator in definitive management of tibia shaft fractures: A prospective observational study of 50 cases

Dwivedi¹,

Rathva²,

Patel³

2017

Int. J. Orthop. Sci.

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Introduction: Tibia shaft fractures can be treated with various modes, each having its merits and demerits. The aim of our study was to analyze clinical outcome of Ilizarov technique in patients with tibia shaft fracture. Method: 50 patients with isolated tibia shaft fracture treated with Ilizarov external fixator were followed prospectively for one year. Depending upon the level of fracture 4 or 5 rings were used. Weight bearing as per patient pain tolerance was allowed within 24 to 48 hours. The decision of frame removal was taken based on Ramos criteria. The function was evaluated based on Johner and Wruh's criteria. Results: According to Johner and Wruh's criteria, 34 patients had excellent, 12 patients had good and 4 patients had fair results. No poor results were noted. There was no case of re-operation and re-fracture. Pin-site infections were seen in 14% cases but there were no deep infections. Conclusion: Ilizarov technique can be used as an early definitive management in tibia shaft fractures with excellent clinical outcome.

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Grade 3 open tibial shaft fractures treated with a circular frame, functional outcome and systematic review of literature

Cited by 53 publications

References 78 publications

Short-term results of grade III open tibia fractures treated with circular fixators

Short-term results of grade III open tibia fractures treated with circular fixators

Outcomes of intramedullary nailing for open fractures of the tibial shaft

Role of Ilizarov ring fixator in definitive management of tibia shaft fractures: A prospective observational study of 50 cases

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