Guidelines for Treatment of Open Fractures and Infected Pseudarthroses by External Fixation

Vidal, J; Buscayret, C; Connes, H; J, Melka; Orst, G

doi:10.1097/00003086-198311000-00012

Cited by 12 publications

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“…External fixation is advantageous because the reduction is maintained by ligamentotaxis, 13,26 and patients with such unstable fractures are not forced to maintain markedly unfavourable fixative position such as the cotton loader position during fixation by plaster. In addition, external fixation is useful for preventing circulatory disorders caused by plaster compression.…”

Section: Discussionmentioning

confidence: 99%

Clinical Results of External Fixation for Unstable Colles' Fractures

et al. 2003

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The objective of this study is to evaluate clinical and radiological outcomes of unstable or intra-articular Colles' fractures using the Pennig model of external fixation. The Pennig model of dynamic external fixation was used on 88 patients with 92 Colles' fractures. In 35 wrists, exercise was not performed during external fixation. In 57 wrists, exercise was initiated three weeks after surgery. Regarding radiological measurements, the degrees of volar tilt (VT), radial inclination (RI), radial length (RL) and ulnar variance (UV) were serially measured and evaluated. The clinical results were evaluated according to Sarminento's criteria. Favourable therapeutic outcomes (excellent and good) were obtained in 95.6% of the cases. However, when complicated by die-punch fractures, the outcome tended to be poorer. Postoperative re-displacement was often observed in patients over 50 years old. UV tended to increase and RL tended to decrease in the early motion group after the initiation of exercise. Neither VT nor RI significantly changed in either group during the postoperative observation period. Of patients in whom bone union of ulnar styloid fractures was not achieved, 32.2% complained of ulnar pain. Moreover, osteoarthritic changes were observed in two of 11 wrists with a step off of 1 to 2 mm or larger. In order to maintain the reduction position, it was important to determine the appropriate time for initiating exercise depending on the degree of fixation in each individual patients. The step off of the articular surface should be reduced to less than 1 mm and reductive fixation has to be performed additionally when complicated by ulnar styloid fractures.

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Section: Discussionmentioning

confidence: 99%

Clinical Results of External Fixation for Unstable Colles' Fractures

et al. 2003

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“…The treatment of infected non-union of long bones, particularly in tibial pseudarthrosis, has four requirements : 1) bone stabilisation by external fixation [18] 2) local treatment of infection with irrigation drainage [6], antibiotic cement [11,12], plaster beads [17], antibiotic fibrin clots [3], collagen fleece [1] or tauroline gel [13] 3) achievement of bone consolidation by traditional surgical operations such as open cancellous bone grafting [16] or free vascular bone grafting [8]. 4) skin covering by various muscle flap techniques [14].…”

Section: Abstract : Tibia I Infection --Pseudarthrosis I Ilizarovmentioning

confidence: 99%

Ilizarov's method in infected tibial pseudarthrosis and for reconstruction of bone defects

Jenny

Mosser³

1993

Orthop Traumatol

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R~sum~. Les auteurs d6crivent la m6thode d'Ilizarov dans le traitement des pseudarthroses infectdes du tibia etdans la reconstruction des pertes de substance osseuse. Cette technique a dtd utilis~e chez 37 patients dans 29 cas de pseudarthroses infectdes du tibia sans perte de substance osseuse et dans 8 cas avec des d6fects osseux consdquents, allant jusqu'gz 15 cm. Les r6sultats ont dtd variables et moins satisfaisants que ceux publi6s par Ilizaroy Iui-mOme ou d'autres auteurs trop enthousiastes. Les rdsultats tardifs sont meilleurs dans les pseudarthroses infect(es sans ddfect osseux (79 % de consolidations et 68 % de tarissements de l'infection) que dans les cas avec perte de substance osseuse (44 % de consolidations et 55 % d'ass~chements). La mdthode d'Ilizarov est considdrer comme difficile d'application et comme astreignante pour le patient comme pour le chirurgien. Ndanmoins, c'est la seule technique permettant [z la fois et dans le m~me temps de traiter l'infection et la consolidation. Abstract. The authors describe Ilizaroy's method for the treatment of infected tibial pseudarthrosis and for reconstruction of diaphyseal bone defects. This technique was used on 37 patients: 29 cases consisted of infected tibial non-unions without bone defect and 8 cases with consequent bone defect between 2 and 15 cm. Results are variable and less satisfactory than those published by Ilizarov himself or other authors. The late results are better in cases of infected pseudarthrosis without bone defect (79 % bone consolidation, 68 % cure of infection) than in cases with extensive bone defect (44 % bone consolidation, 55 % cure of infection). Ilizarov's method must be considered as very demanding for the patient and also for the surgeon. It is however the only technique for treating simultaneously infection and consolidation. The treatment of infected non-union of long bones, particularly in tibial pseudarthrosis, has four requirements : 1) bone stabilisation by external fixation [18] 2) local treatment of infection with irrigation drainage [6], antibiotic cement [11, 12], plaster beads [17], antibiotic fibrin clots [3], collagen fleece [1] or tauroline gel [13] 3) achievement of bone consolidation by traditional surgical operations such as open cancellous bone grafting [16] or free vascular bone grafting [8]. 4) skin covering by various muscle flap techniques [14].Recently Ilizarov [9, 10] has described a new and original method of treatment for infected non unions with or without bone defect. MethodThe Ilizarov technique allows the simultaneous achievement of eradication of infection and bone consolidation without debridement and without bone grafting. In animal studies, Ilizarov showed the importance of a stable but elastic bone stabilization and the role of conservation of the vessels, of the periosteum, the endosteum and the bone marrow.The Ilizarov ring fixator with transfixing Kirschner wires allows absolute rigidity of a long bone pseudarthrosis in flexion and rotation, but preserves some axial elasticity. So, earl...

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“…Many authors prefer nailing over external fixation for tibia fractures [23] [24]. However, there are still some absolute indications for external fixation [25] [26]: type III open fractures, those complicated by vascular damage, and those where treatment is delayed [27] [28]. In the series of Tripuraneni [29], he used external fixation in 78% of cases.…”

Section: Bone Fixationmentioning

confidence: 99%

Time Management of Open Lower-Leg Fractures in Morocco

Magoumou¹,

Andaloussi²,

Fahsi³

et al. 2014

OJEM

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Background: It is recommended that the management of open lower-leg fractures should occur within six hours to avoid complications affecting both prognosis and functionality. This study aimed to evaluate the time taken for each step of management, identify causes of delay, and propose solutions to reduce the rate of complications. Patients and methods: This was a prospective study involving 153 patients treated from January 2011 to December 2012. Standardized data collection forms documented the times taken for each management step from the accident until surgical intervention. Results: For patients admitted directly to our institution, median time to surgical debridement from arrival was 5 hours. Median time for bone fixation was 24 hours. External fixation was used in 119 patients. There were several causes of delay; lack of financial resources was the most common. Certain causes of delay were significantly correlated with time to debridement. However, although 86.7% of patients who developed an infection had a time from injury to debridement greater than six hours, there was no statistically significant association between infection and delay beyond six hours (p = 0.403). Conclusion: By identifying causes of treatment delay, we hope to be able to avoid complications, and therefore reduce the socioeconomic impact of these important surgical emergencies.

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Guidelines for Treatment of Open Fractures and Infected Pseudarthroses by External Fixation

Cited by 12 publications

References 0 publications

Clinical Results of External Fixation for Unstable Colles' Fractures

Clinical Results of External Fixation for Unstable Colles' Fractures

Ilizarov's method in infected tibial pseudarthrosis and for reconstruction of bone defects

Time Management of Open Lower-Leg Fractures in Morocco

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