Single-stage orthoplastic reconstruction of Gustilo–Anderson Grade III open tibial fractures greatly reduces infection rates

Mathews, John; Ward, Jennifer; Chapman, Thomas; Khan, Umraz; Kelly, Mike

doi:10.1016/j.injury.2015.08.027

Cited by 119 publications

(86 citation statements)

References 10 publications

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“…This study was undertaken in a unit where and the vast majority of type IIIB open tibia fractures undergo a twostage approach. [7][8][9] The first stage is a thorough debridement by senior orthopaedic and plastic surgeons, prior to temporary stabilization with either TIF, or ex-fix. The second is a combined approach where the definitive fixation and soft tissue reconstruction is performed in the same operative episode; an approach which has previously been referred to as 'fix and flap'.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Comparative Cohort Study Comparing Temporary Internal Fixation to External Fixation at the First Stage Debridement in the Treatment of Type IIIB Open Diaphyseal Tibial Fractures

Fowler

Whitehouse

Riddick

et al. 2019

Journal of Orthopaedic Trauma

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Objectives: To compare the rates of deep infection, flap failure and nonunion after temporary internal fixation (TIF), with temporary external fixation (ex-fix) in the management of Gustilo-Anderson (GA) type IIIB open tibia fractures. Design: Retrospective comparative cohort. Setting: Level 1 trauma center. Patients/Participants: 64 consecutive patients with a GA type IIIB open diaphyseal tibia fracture (OTA/AO 42) were treated between May 2014 and May 2016. 47 patients (TIF = 24; ex-fix = 23) met the inclusion criteria and underwent two-stage reconstruction. Definitive fixation was with an intramedullary nail.Intervention: Temporary fracture stabilization at the first stage debridement was achieved with either TIF with a plate, or ex-fix. Main Outcome Measurement: Deep infectionResults: There were 4 complications in the ex-fix group (3 infection and 1 nonunion) and 2 complications in the TIF group (1 infection and 1 flap failure). Multiple regression modelling revealed infection (p=0.610), nonunion (p=0.918) and flap failure (p=0.112) were not significantly associated with the mode of temporary fixation or other demographic and treatment variables. The odds ratio of patients treated with TIF developing an infection compared to those treated with an ex-fix was 0.29 (95% CI 0.03 to 3.01).Conclusion: TIF of type IIIB open diaphyseal tibial fractures appears to be a safe alternative to conventional external fixation. Level of Evidence: Therapeutic Level III

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Section: Introductionmentioning

confidence: 99%

A Retrospective Comparative Cohort Study Comparing Temporary Internal Fixation to External Fixation at the First Stage Debridement in the Treatment of Type IIIB Open Diaphyseal Tibial Fractures

Fowler

Whitehouse

Riddick

et al. 2019

Journal of Orthopaedic Trauma

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“…However, due to financial as well as logistic issues, including long operation wait-lists endemic in underdeveloped countries, this single-stage approach would be better suited for overcrowded tertiary care centres in developing countries. Recent studies [45][46][47] also emphasised the importance of single-stage definitive ortho-plastic reconstruction in severe open tibial fractures leading to good outcomes and significantly decreased infection rates.…”

Section: Discussionmentioning

confidence: 99%

Single-stage "Fix and Flap" gives Good Outcomes in Grade 3B/C Open Tibial Fractures: A Prospective Study

Singh¹,

Dhillon²,

Ss³

2020

Malays Orthop J

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Introduction:Grade 3B/C open tibial fractures with grossly contaminated degloving injuries have poor outcomes, with or without vascular injuries. Treatment decision oscillates between limb salvage and amputation. The standard protocol of repeated debridement and delayed wound cover is a challenge in developing countries due to overcrowded emergencies and limited operating room availability. We present results of our modified protocol involving primary stabilisation with external fixation and immediate wound cover as an aggressive modality of treatment. Material and Methods: Thirty-three patients with severe open tibial shaft fractures were managed using a standardised protocol of emergent debridement, external fixation and immediate wound cover with free distant/local rotational muscle flaps and fasciocutaneous flaps, and with vascular repair in Grade 3C fractures. Intra-articular fractures were excluded. Patients were followed for a minimum of three years, with an assessment of clinical, radiological and functional outcomes. Results: Wound cover was achieved with 24 distant free muscle flaps, four local rotational muscle flaps and five fasciocutaneous flaps. All fractures united with an average time to union of 40.3 weeks (16-88). Fifteen patients (45.4%) underwent only a single major surgery using primary definitive external fixation. Deep infection was seen in four patients (12.1%). Nineteen patients had excellent to good outcomes, six were fair, and eight were poor. Conclusion: "Fix and Flap" in the same sitting, using immediate wound cover and external fixation, has given good results in our hands despite the delayed presentation, the neurovascular deficit and the degloving injury. This may be a better management strategy in overcrowded tertiary care centres of developing countries, with a single surgical procedure in almost half the cases.

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“…3,13 Possible aetiological factors include the ageing of the population, the increased prevalence of trauma, the rising prevalence of diabetic foot infections and improvements in the diagnosis of the disease. 3,14 Trauma-induced osteomyelitis remains the most common cause, 15,16 with infection rates in open long bone fractures ranging between 4% and 64%, whereas recurrence rates following bony infection have been reported to be as high as 20% to 30%. 16,17 On the other hand, prosthetic joint infections represent a relatively new entity of chronic osteomyelitis.…”

Section: Epidemiologymentioning

confidence: 99%

“…3,14 Trauma-induced osteomyelitis remains the most common cause, 15,16 with infection rates in open long bone fractures ranging between 4% and 64%, whereas recurrence rates following bony infection have been reported to be as high as 20% to 30%. 16,17 On the other hand, prosthetic joint infections represent a relatively new entity of chronic osteomyelitis. Their incidence is reported to be as high as 1.5% to 2.5%, even though rates of up to 20% have been reported following revision surgery.…”

Section: Epidemiologymentioning

confidence: 99%

Chronic osteomyelitis: what the surgeon needs to know

2016

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Chronic osteomyelitis represents a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation.It may present with periods of quiescence of variable duration, whereas its occurrence, type, severity and prognosis is multifactorial.The ‘gold standard’ for the diagnosis of chronic osteomyelitis is the presence of positive bone cultures and histopathologic examination of the bone.Its management remains challenging to the treating physician, with a multidisciplinary approach involving radiologists, microbiologists with expertise in infectious diseases, orthopaedic surgeons and plastic surgeons.Treatment should be tailored to each patient according the severity and duration of symptoms, as well as to the clinical and radiological response to treatment.A combined antimicrobial and surgical treatment should be considered in all cases, including appropriate dead space management and subsequent reconstruction. Relapse can occur, even following an apparently successful treatment, which has a major impact on the quality of life of patients and is a substantial financial burden to any healthcare system.Cite this article EFORT Open Rev 2016;1:128–135. DOI: 10.1302/2058-5241.1.000017.

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Single-stage orthoplastic reconstruction of Gustilo–Anderson Grade III open tibial fractures greatly reduces infection rates

Cited by 119 publications

References 10 publications

A Retrospective Comparative Cohort Study Comparing Temporary Internal Fixation to External Fixation at the First Stage Debridement in the Treatment of Type IIIB Open Diaphyseal Tibial Fractures

A Retrospective Comparative Cohort Study Comparing Temporary Internal Fixation to External Fixation at the First Stage Debridement in the Treatment of Type IIIB Open Diaphyseal Tibial Fractures

Single-stage "Fix and Flap" gives Good Outcomes in Grade 3B/C Open Tibial Fractures: A Prospective Study

Chronic osteomyelitis: what the surgeon needs to know

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