Soft-Tissue Coverage and Outcome of Gustilo Grade IIIB Midshaft Tibia Fractures: A 15-Year Experience

Choudry, Umar; Moran, Steven L.; Karaçor, Zeynep

doi:10.1097/prs.0b013e31817d60e0

Cited by 57 publications

(43 citation statements)

References 33 publications

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“…Flap (IIIB) Pro [11] Vascular injury Pro [7] Open injury Pro [2,5] Weightbearing status postoperatively Pro [15,26] Con [35] Fibular fracture fixation Pro [15,38] Con [39,42] …”

Section: Bilateral Tibial Fractures Nonementioning

confidence: 99%

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

O’Halloran

Coale

Costales

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Accurate prediction of tibial nonunions has eluded researchers. Reliably predicting tibial nonunions at the time of fixation could change management strategies and stimulate further research. Questions/purposes We asked (1) whether data from medical records, fracture characteristics, and radiographs obtained at the time of fixation would identify features predictive of tibial fracture nonunion; and (2) whether this information could be used to create a model to assess the chance of nonunion at the time of intramedullary (IM) nail fixation of the tibia. Methods We retrospectively reviewed all tibial shaft fractures treated at our center from 2007 to 2014. We conducted a literature review and collected data on 35 factors theorized to contribute to delayed bone healing. Patients were followed to fracture healing or surgery for nonunion. Patients with planned prophylactic nonunion surgery were excluded because their nonunions were anticipated and our focus was on unanticipated nonunions. Our cohort consisted of 382 patients treated with IM nails for tibial shaft fractures (nonunion, 56; healed, 326). Bivariate and multivariate regression techniques and stepwise modeling approaches examined the relationship between variables available at definitive fixation. Factors were included in our model if they were identified as having a modest to large effect size (odds ratio [ 2) at the p \ 0.05 level. Results A multiple variable logistic regression model was developed, including seven factors (p \ 0.05; odds ratio [ 2.0). With these factors, we created the Nonunion Risk Determination (NURD) score. The NURD score assigns 5 points for flaps, 4 points for compartment syndrome, 3 points for chronic condition(s), 2 points for open fractures, 1 point for male gender, and 1 point per grade of American Society of Anesthesiologists Physical Status and percent cortical contact. One point each is subtracted for spiral fractures and for low-energy injuries, which were found to be predictive of union. A NURD score of 0 to 5 had a 2% chance of nonunion; 6 to 8, 22%; 9 to 11, 42%; and[12, 61%. Conclusions The proposed nonunion prediction model (NURDS) seems to have potential to allow clinicians to better determine which patients have a higher risk of nonunion. Future work should be directed at prospectively validating and enhancing this model. Level of Evidence Level III, diagnostic study.

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“…Flap (IIIB) Pro [11] Vascular injury Pro [7] Open injury Pro [2,5] Weightbearing status postoperatively Pro [15,26] Con [35] Fibular fracture fixation Pro [15,38] Con [39,42] …”

Section: Bilateral Tibial Fractures Nonementioning

confidence: 99%

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

O’Halloran

Coale

Costales

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…This is an important point, also observed by Choudry et al, illustrating that a flap revision or a second flap can often allow limb salvage [20]. At our institution, local muscle flaps are not used for immediate soft tissue cover after lower extremity trauma due to high complication and revision rates [3,18,20].…”

Section: Discussionmentioning

confidence: 78%

“…Choudy et al also found a higher non-union rate and infection rate in patients with flap cover after day seven [20]. Gopal et al and Sinclair et al reported series of open tibial fractures with very early skin cover (before day three) and definitive stabilization; 90-95 % of these patients had successful flap cover, with no infection, union of the fracture and excellent outcome without pain or walking disability [4,5].…”

Section: Discussionmentioning

confidence: 93%

A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors

Olesen

Juul

Bonde

et al. 2015

International Orthopaedics (SICOT)

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“…[22] 2004 Free tissue transfer + radiotherapy Choudry et al . [23] 2008 Free tissue transfer Saito et al . [24] 2010 Free tissue transfer + bone reconstruction Zweifel-Schlatter et al .…”

Section: Thighmentioning

confidence: 99%

“…In addition to considering the need for adjuvant radiotherapy, the soft tissue of this area is very thin and must provide a smooth surface for the tendons underneath. Traditional flaps used to cover defects of the distal third of the foot have included the rectus abdominis, latissimus dorsi, gracilis, and rectus femoris flaps [23] . Free scapular and ALT flaps have also been used with adequate results [24] .…”

Section: Ankle/footmentioning

confidence: 99%

Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Azadgoli¹,

Carre²,

Perrault³

et al. 2018

PAR

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While amputation was traditionally the only option available for patients with sarcomas of the extremities, chemotherapy, radiation, and advances in microsurgical technique have allowed many patients to undergo limb-salvaging procedures. Given the low incidence and heterogeneity of these tumors, there is currently no standard treatment algorithm for limb reconstruction after large sarcoma resection. Thus, we systematically reviewed the various types of free tissue transfer used for the reconstruction of lower limbs after sarcoma resection. Techniques were described based on anatomic location. This literature review supports free tissue transfer as a safe and acceptable modality for reconstruction after sarcoma resection of the lower limb. It allows for the application of healthy vascularized tissue to the defect while also providing freedom of flap positioning. Flap choice is dependent on tumor and defect size, tissue type and function, as well as donor site availability.

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Soft-Tissue Coverage and Outcome of Gustilo Grade IIIB Midshaft Tibia Fractures: A 15-Year Experience

Abstract: Soft-tissue coverage is not the only determinant for successful outcome. Delayed coverage resulted in higher nonunion rates. Despite high nonunion rates, 89 percent of fractures ultimately healed successfully.

Cited by 57 publications

References 33 publications

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors

Complex reconstruction of the lower extremity following sarcoma resection: a literature review

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