Open segmental fractures of the tibia treated by external fixation

Golubović, Ivan; Vukašinović, Zoran; Stojiljković, Predrag; Golubović, Zoran; Stamenić, Sonja; Najman, Stevo

doi:10.2298/sarh1212732g

Cited by 6 publications

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“…Although intramedullary nail is the gold standard in the management of tibial diaphyseal fractures, external xation has a clear role in most cases due to the advantage of stabilization with limiting soft tissue dissection, especially for high-energy injuries with poor surrounding soft tissues 3,4,6,8,10,14,17,21 .…”

Section: Discussionmentioning

confidence: 99%

“…Although open reduction and internal xation (ORIF) which contributes to anatomic reduction has acted as the gold standard for diaphyseal fractures treatment, it is the most invasive form with potential infection risk, especially for high-energy fractures with severe soft tissue damage. Meticulous soft tissue care combined with external xation has given satisfactory clinical results in recent years [3][4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes in the Definitive Treatment of High-energy Tibial Diaphyseal Fractures using Hexapod External Fixator Versus Monolateral External Fixator

Liu¹,

Liu²,

Cai³

et al. 2021

Preprint

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Background: External fixation, which can preserve the biomechanical microenvironment of fracture healing, playing an important role in managing the high-energy fractures with poor surrounding soft tissues. The purpose of this study was to determine the differences of clinical outcomes, if any, between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures.Methods: A total of 53 patients with high-energy tibial diaphyseal fractures and definitively treated by the hexapod external fixator (HEF) or monolateral external fixator (MEF) were retrospectively collected and analyzed, from March 2015 to June 2019. There were 31 patients in the HEF treatment, and the other 22 patients were managed by the MEF. The demographic data, surgical duration, external fixation time, final radiological results, complications, and clinical outcomes were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: The mean surgical duration in the HEF group (62.4±8.3 minutes) was shorter than that in the MEF group (91.4±6.9 minutes) (P<0.05). All patients acquired complete bone union finally. Patients in the HEF group (24.2±3.1 weeks) underwent a shorter average external fixation time than that in the MEF group (26.3±3.8 weeks) (P<0.05). Satisfactory alignment was achieved in all patients without the need for remanipulation. The residual sagittal plane deformities in the HEF group were all less than that in the MEF group (P<0.05). The complication rate was 35.5% in the HEF group, while 45.5% in the MEF group. There was no statistically significant difference between the two groups in ASAMI scores (P>0.05).Conclusion: There is no statistically significant difference in finally clinical outcomes between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. The hexapod external fixation treatment is a superior effective method, including advantages of stable fixation, less surgical duration, postoperatively satisfactory fracture reduction, and fewer complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes in the Definitive Treatment of High-energy Tibial Diaphyseal Fractures using Hexapod External Fixator Versus Monolateral External Fixator

Liu¹,

Liu²,

Cai³

et al. 2021

Preprint

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“…Early parenteral antibiotic administration is associated with the infection incidence decrease and should be applied immediately upon admission. Antibiotic treatment is to be administered during 48 to 76 hours in patients with grade I and II and up to 120 hours in patients with grade III open fractures (9).…”

Section: Discussionmentioning

confidence: 99%

Primary Wound Care a Nd External Skeletal Fixation in Surgical Treatment of Open Tibial Fractures

Golubović¹,

Stojiljković²,

Golubović³

et al. 2018

AMM

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Open tibial fractures are the most severe orthopaedic injuries. The lower leg is often injured due to its position in the locomotor system. The injuries of the lower leg skin and soft tissues, bone comminution and threatening infections make the treatment of these fractures particularly complex. The management of open tibial fractures is potentially associated with numerous complications. The data on treatment outcomes of 36 patients operatively treated for the open tibial fractures in Clinic for Orthopaedic surgery and traumatology, Clinical Center Nis in Serbia during the period from January 1, 2012 to June 31, 2014 were retrospectively analyzed and compared. In all the patients, after thorough wound rinsing, removal of the foreign bodies, debridement and delayed wound closure, fractured bone segments were repositioned and stabilized using external fixator. In 28 (77.78%) patients fractures healed without major complications, while in 8 (22.22%) major complications occurred, including tibial osteomyelitis in 3 (8.33%) and fracture malunion in 5 (13.88%) patients. Primary wound care, external fixation, antibiotic and antitetanus prophylaxis are crucial in treatment of open tibial fracture.

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“…During the injury of the blood vessels, the opening of the lumen can happen (laceration, transection) with resultant bleeding, or obstruction of the flow (thrombosis) and the interruption of circulation. These injuries usually occur in traffic accidents, under the high intensity force, whereas beside lesions of the main blood vessel, there is a great damage of the soft tissues of the lower leg and periosteum removal from the injured bone in the fracture segment 3,8 .…”

Section: Discussionmentioning

confidence: 99%

“…Postoperatively, the vascular status of extremities should be estimated. If there is some doubt, intraoperative or postoperative arteriography should be applied 3,8,9 .…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of the lower leg open fracture with lesions of the main blood vessels. A case report

et al. 2018

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Introduction. Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work. [Projekat Ministarstva nauke Republike Srbije, br. III 41017: Virtual human osteoarticular system and its application in preclinical and clinical practice]

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Open segmental fractures of the tibia treated by external fixation

Cited by 6 publications

References 0 publications

Clinical Outcomes in the Definitive Treatment of High-energy Tibial Diaphyseal Fractures using Hexapod External Fixator Versus Monolateral External Fixator

Clinical Outcomes in the Definitive Treatment of High-energy Tibial Diaphyseal Fractures using Hexapod External Fixator Versus Monolateral External Fixator

Primary Wound Care a Nd External Skeletal Fixation in Surgical Treatment of Open Tibial Fractures

Surgical treatment of the lower leg open fracture with lesions of the main blood vessels. A case report

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