Placing Locking Compression Plates as an External Fixator in Wild Animal (Crocodile) Bite Victim: A Case Report.

Objective To evaluate the external fixators used in early treatment of severe open tibiofibular fractures following the 5.12 earthquake in Sichuan, China. Methods From 12th to 17th of May, 2008, we admitted a total of 116 open tibiofibular fractures of grade Ⅲ in 83 patients who were injured in the Sichuan earthquake catastrophe. They were treated by radical debridement combined with external fixation. Early effects of our treatment were analyzed in terms of incidence of deep infection, amputation and wound healing. Results The short term observation showed that the overall infection rate for all grade Ⅲ open tibiofibular fractures was 17.2% (20 factures). Amputation of limbs was done for 9 fractures of grade Ⅲ C due to ischemic necrosis and 1 fracture of grade III b due to infective necrosis complicated with septicopyemia. The total amputation rate was 8.62%. Twenty injured limbs had deep infections which were controlled by repeated debridement and curettage. Union rate was 100% among all the saved limbs, although some cases required free tissue transfer or rotational muscle flap coverage. Wounds healed by first intention in 52 cases and by second intension in 54 cases. Conclusion In the early treatment of severe open tibiofibular fractures following an earthquake, external fixation may be a useful instrumentation. Key words: Earthquake; Tibia; Fibula; Fracture, open; External fixator

Objective To characterize emergent treatment of open distal tibiofibular fractures in earthquake rescue in comparison with conventional medical treatment.Methods From 21 to 27 April,2013,we treated 12 patients with open distal tibiofibular fracture who had been injured in the earthquake at Lushan,Yaan,Sichuan,China.They were 5 men and 7 women,aged from 33 to 85 years (average,54.8years).By the Gustilo classification,there were 5 cases of type Ⅱ,4 cases of type ⅢA and 3 cases of type Ⅲ B.Two patients were complicated with ipsilateral closed fracture of the knee.Emergent debridement and external fixation with Hoffmann assembled fixator were performed for 11 patients while one patient received external fixation 5 days after injury.Secondary correction of the external fixation was conducted for those with poor alignment or ankle dislocation after primary management.Results Among the 11 patients receiving emergent debridement and external fixation,4 had satisfactory alignment of the lower limb but 7 did not.Of them,4 with mild injury of the soft tissue received direct correction of the alignment of the lower limb when the external fixation was changed while the other 3 with severe injury of the soft tissue or with ankle dislocation or fracture received secondary correction of the external fixation.Good alignment,good fracture reduction and perfect congruence of adjacent joints were achieved in all patients.Conclusions Open distal tibiofibular fractures can be treated quickly and efficiently using an assembled external fixator in earthquake rescue.Initial restoration of the limb alignment and congruence of adjacent joints are crucial and secondary adjustment of the external fixation is necessary for those with poor reduction in case their final treatment and functional recovery are affected by later transportation. Key words: Tibial fractures; Fibula; Fractures, open; External fixator; Earthquake

Objective To compare the clinical efficacy of locking compression plate (LCP) versus intramedullary nail in staged treatment of complex compound tibial fractures.Methods From February 2008 to January 2013,55 cases of complex tibial open fracture were treated at our department.They were 39 men and 16 women,with an average age of 32.5 years (from 17 to 72 years).The fractures were on the left side in 24 patients,on the right side in 28 and both sides in 3.By Gustilo classification,18 fractures were type Ⅰ,24 type Ⅱ and 16 type ⅢA; by AO classification,6 fractures were type 42-A,32 type 42-B,and 20 type 42-C.They were treated by external fixation and vacuun sealing drainage (VSD) at the primary stage followed by fixation with LCP or intramedullary nail at the secondary stage.Locking intramedullary nail was used in 32 patients (34 fractures) and LCP in 23 patients (24 ffractures).The 2 groups were compared in terms of fracture healing time,functional recovery of the affected limbs,and postoperative complications.Results The 55 patients were followed up for 12 to 34 months (average,18 months).All the fractures were healed from 16 to 48 weeks after the staged treatment,with an average of 24.2±5.3 weeks in the intramedullary nail group and 26.1 ± 7.2 weeks in the LCP group.There was no significant difference in the healing time between the 2 groups (P ＞ 0.05).According to the functional assessment by the Johner-Wruhs system,the intramedullary nail group had 13 excellent cases,18 good ones and 3 fair ones (the excellent to good rate,91.2％) while the LCP group had 9 excellent,12 good and 3 fair ones (the excellent to good rate,87.5％),showing no significant between-group difference (P ＞ 0.05).There was no significant difference either between the 2 groups regarding the postoperative complication rate [20.6％ (7/34) for the intramedullary nail group versus 12.5％ (3/24) for the LCP group] (P ＞ 0.05).Conclusion In the staged treatment of complex open tibia fractures,both intramedullary nail and LCP can result in reliable fixation of the fracture ends,a low complication rate and thus satisfactory clinical efficacy. Key words: Tibial fractures; Fractures, open; External fixator; Bone nails; Bone plates

Background: The definitive treatment of open tibial shaft fractures remains challenging and nonunion after treatment of open tibial shaft fractures with external fixation complicates a significant proportion of cases. There are varying rates of occurrence of nonunion and the prevalence is not well known in Ethiopia. The objective of the study is to assess the prevalence and associated factors of nonunion in open tibial shaft fractures treated with EX FIX in TGSH. Methods: The study was conducted using a cross-sectional study in patients with open tibial shaft fractures who were admitted and treated with external fixation in the Tibebe Ghion Specialized Hospital orthopedics department from January 1, 2019, to January 29, 2021. The study involved 75 patients, which was the total number of cases in the study period and fulfilled the inclusion criteria. Bivariate and multiple variable logistic regression analyses were used to analyze the association between variables. The degree of association between variables was determined at the p-value of <0.05. Results: The overall prevalence of nonunion in open tibial shaft fractures treated with external fixation in TGSH was 21.3%. The severity of the injury, presence of wound infection, and treatment factors affect the occurrence of nonunion. It occurs in 9 of 19 (47.4%) Gustilo-Anderson grade IIIB fractures and 6 of 48 (12.5%) Gustilo-Anderson grade IIIA fractures. A delay in soft tissue covering of Gustilo-Anderson grade IIIB fracture of 15 days or more increases the nonunion rate to 72.7%. Nonunion occurred in 41.7% of cases with SSI and 11.8% of cases without SSI. Gustilo-Anderson grade (AOR=4.85, CI 95%: 1.31-18.01), surgical site infection (AOR=4.12, CI 95%: 1.11-15.26), and time until coverage of bone of Gustilo-Anderson grade IIIB fracture (AOR=18.23, CI 95%: 1.17-284.8) have statistically significant association with nonunion. Conclusion and Recommendation: External fixation use for definitive treatment of open tibial fractures should be disfavored as the prevalence of nonunion in open tibial shaft fractures treated with EX FIX is higher than other previous studies done in European and Asian countries. Gustilo-Anderson grade of injury, surgical site infection, and time from injury to bone coverage of Gustilo-Anderson grade IIIB fractures were found to be statistically significantly associated with the occurrence of nonunion. Therefore, attention should be given to early soft tissue reconstruction of exposed bones to establish a favorable environment for bone healing and to make treatment with internal fixations possible. Better management of wounds to minimize surgical site infections is required for better healing of open tibial shaft fractures. Prospective studies are also recommended on the issue.

Open fractures of the femoral shaft, treated with osteosynthesis or temporary external fixation

Objective To explore the clinical effect of radial extracorporeal shock wave therapy in the treatment of postoperative delayed union of open tibial fractures. Methods A total of 41 patients with delayed union after external fixator fixation of open tibial fractures treatment by extracorporeal shock wave from January 2014 to February 2018 were selected. All the patients were followed up after treatment and the effect of treatment was observed. Results All the patients were followed up for 9 months, including 37 cases of fracture healing, and the cure rate was 90.2%. Conclusions Radial extracorporeal shock wave therapy is efficient in the treatment of postoperative delayed union of open tibial fractures, the effect is satisfactory and the complications are few. It is an iseal treatment method. Key words: Radial extracorporeal shock wave therapy; Tibial; Open fractures; Delayed unions

This retrospective case series evaluates the technique of transverse debridement, acute shortening and subsequent distraction histogenesis in the management of open tibial fractures with bone and soft tissue loss, thereby avoiding the need for a soft tissue flap to cover the wound. Thirty-one patients with Gustilo grade III open tibial fractures between 2001 and 2011 were initially managed with transverse wound extensions, debridement and shortening to provide bony apposition and allowing primary wound closure without tension, or coverage with mobilization of soft tissue and split skin graft. Temporary monolateral external fixation was used to allow soft tissues resuscitation, followed by Ilizarov frame for definitive fracture stabilization. Leg length discrepancy was corrected by corticotomy and distraction histogenesis. Union was evaluated radiologically and clinically. Patients’ mean age was 37.3 years (18.3–59.3). Mean bone defect was 3.2 cm (1–8 cm). Mean time to union was 40.1 weeks (12.6–80.7 weeks), and median frame index was 75 days/cm. Median lengthening index (time in frame after corticotomy for lengthening) was 63 days/cm. Mean clinic follow-up was 79 weeks (23–174). Six patients had a total of seven complications. Four patients re-fractured after frame removal, one of whom required a second frame. Two patients required a second frame for correction of residual deformity, and one patient developed a stiff non-union which united following a second frame. There were no cases of deep infection. Acute shortening followed by distraction histogenesis is a safe method for the acute treatment of open tibial fractures with bone and soft tissue loss. This method also avoids the cost, logistical issues and morbidity associated with the use of local or free-tissue transfer flaps and has a low rate of serious complications despite the injury severity.

Management of neglected open extremity fractures in low-resource settings: Experience of the French Army Medical Service in Chad

Efficacité de la fixation interne précoce associée à un lambeau libre pour le traitement des fractures ouvertes de l’avant-bras Gustilo IIIB

To evaluate the incidence of knee sepsis after suprapatellar (SP) nailing of open tibia fractures. Retrospective; Setting: ACS level 1 trauma center. We reviewed 139 open tibia fractures that underwent SP nailing as definitive treatment over a 5-year period (January 1, 2011 to January 1, 2016). Most patients (90%, n = 126) underwent intramedullary nailing at the time of their initial surgery. We defined knee sepsis as intra-articular infection requiring operative debridement, either open or arthroscopically, within 1 month's time. Open tibia fractures treated with an SP tibial nail. Demographic data, fracture characteristics, Gustilo and Anderson classification of open fractures, and occurrence of knee sepsis. In 139 open tibia fractures, there were no cases of knee sepsis in the 30 days after treatment with an SP intramedullary nail. Eighty-seven percent of our cohort had Gustilo and Anderson type II (41%) or type III (46%) open fractures. Most open fractures (83%) underwent primary wound closure during the index procedures. Twenty-five limbs (18%) had evidence of infection at the open fracture site of their open fracture necessitating operative intervention and/or antibiotics: none, however, developed knee sepsis. Although the SP approach carries intra-articular risks, we found a low risk of knee sepsis using this technique in the treatment of open tibia fractures. Our data suggest that there is no greater risk of intra-articular infection using an SP portal as compared with an infrapatellar one. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

ObjectiveTo report outcomes of treating open pelvic fractures with external fixation and vacuum sealing drainage.MethodsSeven open pelvic fractures patients were treated at our hospital from November 2004 to April 2010. They were 3 males and 4 females, aged from 2 to 43 years (mean, 29. 3years). The fractures were caused by traffic accidents (4 cases), falling (one case), smashing (one case) and crushing (one case). According to the Tile classification, 5 were type B1, one was type B2 and one type C1.All were complicated with injuries to soft tissue and organs. By the Gustilo-Anderson classification, open injury was all type Ⅲ, involving soft tissues around the ilium, hip, perineum and inguina. The injury severity score (ISS) ranged from 29 to 57(average, 40.4) . The fractures were treated with external fixation and the wounds with vacuum sealing drainage.ResultsOne patient died during early treatment and 3 had to sustain amputation of the acetabulum. Six patients were followed up for 1.5 to 67 months (mean, 27.6 months). Five patients reported good functional response in fracture healing and fine wound repairing outcome.One case reported good tissue generation after wound skin grafting and fundamental fracture healing. Two cases respectively reported erectile dysfunction of penis and functional disorder of defecation.ConclusionIn treatment of open pelvic fractures, external fixation and vacuum sealing drainage can effectively stabilize the pelvic ring and reduce bleeding and complications as well. Key words: Pelvis; Fractures, open; External fixator; Drainage

The experience of treatment of open femur fractures is discribed. In 113 (77,40%) cases the diaphyseal fracture were diagnosed, in 32 (21,92%) - fractures of distal femur; 90,63% of fractures were intraarticular. The results of the primary, delayed internal fixation of open fractures of the femur and external fixation.

Is primary total elbow arthroplasty safe for the treatment of open intra-articular distal humerus fractures?

The patient with a complex open fracture of the tibia presents a difficult problem. The high energy traumatic forces cause displacement and comminution of the bone and soft tissue damage with associated skin loss, all of which complicate treatment. Wound healing in these complex injuries implies healing of the soft and hard tissues. The concept of the open fracture wound, which involves the bone, the periosteum, the muscle, the fascia, and the skin, emphasizes the interrelated healing process of the soft and the hard tissues (Jones and Cierny, 1980). Management of such complex open tibia fractures by external skeletal fixation stabilizes the fracture and allows ready access for soft tissue wound Observation. Karlstrom and Olerud (1975) documented less wound healing disturbances when Type II or Type III open tibia fractures were treated with external rather than internal fixation. They hypothesized that the creation and maintenance of a favorable mesenchymal milieu accomplished by transportation of pedicle muscle flaps would enhance soft and hard tissue healing in Type III tibia open fracture wounds.

Background: Tibial shaft fractures including open tibial fractures grade III are one of the most common fractures of long bones. There are many methods of conservative and operative treatment, one of them is external fixation. External fixation is more common used temporary in polytraumatized patients with tibial shaft fractures. The study was undertaken to see if the patient can be treated with external fixation as the definitive treatment and evaluate the functional outcome after the treatment.Subjects and Method: A retrospective review of a prospectively-collected database was performed. Data was taken from the Orthopaedic Department of RSUD Dr. Moewardi Hospital patients’ database. The study included all patients who underwent grade III open tibial fracture treatment from May 2018 to May 2019. A total of 8 patients who were included in our study were a patient with open tibial fractures grade III planned for external fixaton as definitive treatment. They were evaluated radiographically and clinically to determine the union rate. The data were reported descriptively.Results: External fixator time ranged in this study around 240 days. In this study, there were a few patients whose progress were remain unknown due to loss of contact. Fractures studied 5 out of 8, no patient were union after 8 months of external fixator used. 4 out of 8 patients were reported non-union after 8 months based on their radiological examination (50%) and 1 out of 8 patients were reported has been performed Removal of External Fixation (ROEF) after 5 months of treatment. The rest of the 3 patients’ results were remain unknown.Conclusion: Open tibial fractures grade III of the leg can be managed with use of external fixator as a definitive treatment. However, the use of external fixation does not provide maximum results in grade III A tibial fractures.Keywords: open tibial fractures, external fixation, union, malunionCorrespondence: Bintang Soetjahjo. Dr. Moewardi General Hospital. Jl. Kolonel Sutarto 132, Jebres, Surakarta, Central Java, Indonesia. 57126. Email: bjortho@yahoo.com. Indonesian Journal of Medicine (2021), 06(04): 452-459https://doi.org/10.26911/­theijmed.2021.06.04.11