Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series

Abstract

BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies. Our aim was to provide an overview of the largest single-center experience in the literature, with minimum 1-year follow-up, of adult type 3 open tibial shaft fractures at Cambridge University Hospitals (a United Kingdom major trauma center). We sought to define patient characteristics and our main outcome measures were infection, union and re-fracture. AIM To retrospectively define patient and injury characteristics, present our surgical methods and analyze our outcomes–namely infection, union and re-fracture rates. METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020 (26 classified as Gustilo-Anderson 3A, 47 were 3B and two were 3C). Nine patients underwent intramedullary nailing (IMN), 61 underwent Taylor spatial frame (TSF) fixation and 5 were treated with Masquelet technique (IMN and subsequent bone grafting). RESULTS Mean follow-up was 16 mo (IMN) and 25 mo (TSF). We had an infection rate of 6.7% (5), non-union rate of 4% (3) and re-fracture rate of 2.7% (2). Average time to union was 22 wk for IMN and 38.6 wk for TSF. Thirty-three cases had a bone defect with a mean of 5.4 cm (2-11). Patient age, sex, diabetes, smoking status or injury severity did not have a significant effect on union time with either fixation method. Our limb salvage rate was 98.7%. CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN. Grade 3B/C injuries are best treated by circular external fixators as they provide good, reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.

The Clinical Application of Double Taylor Spatial Frame in Segmental Tibial Fracture

“…Furthermore, the mechanical load test of the external frame guides patients' rehabilitation exercises and subsequent frame removal, leading to precise, comprehensive, and intelligent fracture treatment. 14,15,[18][19][20][21] Effectiveness of D-TSF for Segmental Tibial Fracture In our retrospective study, we evaluated the effectiveness of D-TSF for segmental tibial fracture fixation. Our findings revealed a mean fracture healing time of (33.33 AE 8.21) weeks and a mean external frame removal time of (36.24 AE 8.34) weeks, consistent with previous reports.…”

“…Furthermore, the mechanical load test of the external frame guides patients' rehabilitation exercises and subsequent frame removal, leading to precise, comprehensive, and intelligent fracture treatment. 14 , 15 , 18 , 19 , 20 , 21 …”

“…We optimized the TSF based on individual fracture characteristics to provide intraoperative multiplanar stabilization of different fracture segments, allowing for segmental fracture repositioning and lower limb force line adjustment. Furthermore, the mechanical load test of the external frame guides patients' rehabilitation exercises and subsequent frame removal, leading to precise, comprehensive, and intelligent fracture treatment 14,15,18–21 …”

“…Patients in the D-TSF and Ilizarov groups were followed for a median of 14 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months. No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05; Table 3).…”

Accuracy of correction of a hexapod frame, patient-specific osteotomy and reduction guides, and hinged circular external fixation in a 3D-printed canine antebrachial deformity model

“…Hexapod systems have been extensively used in human orthopedics over the last 25 years. The ability for simultaneous correction in all three planes, negating the need for sequentially hinged Ilizarov constructs, has proven precise and efficient for fracture repair ( 14 ), deformity correction, distraction osteogenesis ( 15 , 16 ), and as an adjunctive aid for bone positioning prior to internal fixation ( 17 ).…”