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At least 703 records · Page 39Linked to original sources
PubMed2003

Ilizarov external fixator for open fractures of the tibial shaft.

Between December 1993 and 1999 we treated 34 open tibial diaphyseal fractures. Thirty patients were available for evaluation with a mean follow-up after fracture union of 40.5 (24-80) months. Patient average age was 33.1 (15-71) years. Two fractures were grade I, 16 grade II, six grade IIIA, five grade IIIB and one grade IIIC. The wound was debrided and the bone fixed with Ilizarov device. Soft-tissue healing was achieved through Z-plasty, delayed primary closure, split-thickness skin grafting, pedicle flaps and skin traction, and all fractures united with an average 5.6 (3-15.4) months. In 28 patients the results were excellent and good, in one fair and in one poor. Despite numerous complications the use of Ilizarov external fixator provides initial and definitive fracture stability.

Adolescent↗
PubMed1994

[Emergency cover of open fractures of the leg. Apropos of a series of 24 clinical cases].

The authors present 24 emergency covering procedures for 24 open leg fractures: 6 free flaps and 18 pedicled flaps. The procedure was selected according to the site dimensions and topography of the defect. Topographically, the division of the leg into 3 zones: middle, upper and lower seems to be some what artificial because in practice the junction between the middle and lower segments is still a source of error in the choice of the local flap which can be used. It is preferable to use pedicled flaps in the proximal half of the tibia and free flaps in the distal half. Many failures were observed with the use of fascio-cutaneous flaps. 18 of 24 fractures were internally fixed, which allowed emergency covering. In fact, although bony covering can wait 48 hours, the presence of osteosynthesis material means that covering must be performed at the same time. This makes the plastic and microsurgical procedures easier and ensures greater patient comfort during the consolidation period and rehabilitation. The authors present their results according to the method of soft tissue coverage, their reliability, the type of osteosynthesis, the complications, number of operations and time to bony consolidation. Encouraged by their results, the authors continue with this approach.

Emergencies↗
PubMed2005

Management of shotgun induced open fractures of the humerus with Ilizarov external fixator.

BACKGROUND: Our aim was to evaluate the clinical efficacy of Ilizarov external fixator used for the management of shotgun induced open humeral fractures with special emphasize on neurovascular sequelae. METHODS: The authors retrospectively reviewed eleven shotgun induced open humeral fractures managed with emergent application of Ilizarov external fixator. No patient had associated neurovascular injury. All fractures were stabilized with Ilizarov external fixator immediately after meticulous debridement and irrigation under emergent conditions. RESULTS: With Ilizarov fixation technique complete bony union occurred in all patients within 14 to 44 weeks (average, 21 weeks) postoperatively. One patient required a second intervention in order to adjust the external fixator rings. Two patients required a rotational fasciocutaneous flap so as to handle the soft tissue coverage problem. Superficial pin tract infection was present in eight patients, however in none of the patients deep tissue infection or osteomyelitis has been observed. Good to excellent results were achieved in 10 patients with Ilizarov fixation technique according to the rating system proposed by Smith and Cooney. CONCLUSION: Emergent Ilizarov external fixation is a safe method of obtaining a functional limb in the management of shotgun induced open humeral fractures with severe soft tissue damage.

Adolescent↗
PubMed2004

Anterior interosseous nerve palsy after reduction and percutaneous pinning of open fractures of the radius and ulna.

We report a case of an anterior interosseous nerve palsy after closed reduction and percutaneous pinning of open fractures of the radius and ulna in an adult. Operative findings showed that the anterior interosseous nerve was trapped between the distal and proximal part of the fractured radius. Treatment by neurorrhaphy gave a satisfactory result.

Fracture Fixation, Intramedullary↗
PubMed2002

Open fractures of the distal radius.

A review of 18 patients treated at our institution for open distal radius fractures was performed. The patients were followed up for an average of 32 months (range, 12 months to 5.3 years). Wounds were classified according to Gustilo and Anderson with 9 type I (50%), 3 type II (17%), and 6 type III (34%) (3 IIIa, 2 IIIb, 1 IIIc) injuries. Seven patients underwent a total of 2 to 4 procedures to treat their injuries, and 3 patients required 5 or more procedures. Eleven (61%) patients had postoperative complications. Patients were evaluated with the Disabilities of the Arm, Shoulder, and Hand questionnaire and scored an average of 33. Wound severity was associated with an increased number of postoperative complications (p =.012), an increased number of complications per patient (p =.015), a higher number of surgical procedures (p =.003), a decreased average range of motion (p =.235), and fair or poor results at the latest follow-up (p =.03). Although type I injuries may be similar to their closed counterparts, patients with type III injuries experienced a much greater number of initial complications and had worse long-term clinical outcomes.

Adolescent↗
PubMed1995

Open fractures of the patella: long-term functional outcome.

Seventy-nine open patella fractures in 76 patients were treated between 1986 through 1994, with an 80% incidence of multiple injuries. All were treated with irrigation and debridement, open reduction, internal fixation, and reconstruction of the extensor mechanism. In no case was a primary patellectomy performed, even with severe comminution. There were three failures of initial fixation and one asymptomatic nonunion. Average range of motion for all groups was 112 degrees, at an average follow-up of 21 months. Secondary surgical procedures were performed in 65% of knees, the majority for symptomatic hardware. To determine long-term functional outcome, a modified Hospital for Special Surgery knee score was used. At an average of 36 months, good to excellent knee scores were observed in 17 of 22 patients. We conclude that all attempts for preservation of bone substance and precise reconstruction of the extensor should be attempted, reserving total patellectomy as a salvage procedure.

Adult↗
PubMed1990

Closed intramedullary tibial nailing. Its use in closed and type I open fractures.

We present the results of using the Grosse-Kempf interlocking nail in the management of 125 closed and type I open tibial fractures. The mean time to union was 16.7 weeks and no fracture required bone grafting. Mobilisation of the patient and the range of joint movement were better than with other methods of treating tibial fractures. There was a 1.6% incidence of infection; 40.8% of patients had knee pain and 26.4% needed to have the nail removed. Other complaints were minor. We suggest that closed intramedullary nailing with an interlocking nail system is an excellent method of treating closed and type I open tibial fractures.

Adolescent↗
PubMed1990

[Treatment of open fractures of the foot using external fixation].

The authors give an account of their experience with the use of compression--distraction for the treatment of open dislocation fractures of the foot. The device was designed by the authors and the results are satisfactory when the apparatus is used in the mentioned indications.

External Fixators↗
PubMed1983

[2d- and 3d-degree open fractures of the long tubular bones--therapeutic management and treatment results].

In compound fractures, after debridement and stabilisation, primary open wound treatment with synthetic skin substitute is the method of choice. A follow-up examination of 171 second- and third-degree compound fractures between April 1974 and June 1981 showed an infection rate of 18,7% and an osteitis rate of 14,6%. In 23 cases conservative surgery was performed, in 17 cases primary amputation was necessary. In 85% of all cases bone healing was achieved after an average of 5,4 months.

Adolescent↗
PubMed1982

Open fractures of the shaft of the tibia treated by intramedullary nailing.

The technique and results of treating 57 selected open tibial shaft fractures by intramedullary nailing are reviewed. All but three of the the fractures were located in the middle third of the tibia; two thirds of these were transverse or short obliques. Excellent or good results were obtained in 87.7 percent of all cases. The mean time to union of Type I fractures was 12.6 weeks, of Type II fractures 15 weeks, and of Type III fractures 20.5 weeks. Complications included two infections in two of the Type III fractures.

Adult↗
PubMed1985

Mucormycosis after open fracture injury.

An 18-year-old woman (a former intravenous drug abuser) sustained open tibial plateau and shaft fractures, followed by cellulitis and a wound infection caused by a Rhizopus species, which is a fungus of the class Mucorales. The patient responded to surgical debridement and a prolonged course of amphotericin B. No lymphocyte abnormality or other host immune defect could be demonstrated in this patient.

Accidents, Traffic↗
PubMedDate not supplied

[Treatment of supramalleolar open fractures by means of centro-medullary osteosynthesis of the fibula].

The study is concerned with 11 cases of open supra-malleolar fractures involving both bones. The tibial fracture was of the comminutive type, with a large number of small fragments allowing an exteriorization of the proximal end or telescoping of the ends with consecutive loss of the axis. Due to a difficult synthesis of the tibial bone synthesis of the peroneum with a thick rod or with a brooch was performed, recovering the length of the lever and allowing to de-telescope the tibial focus, to recover the normal length and a corresponding axis. Since in all the treated cases consolidation was achieved over a duration of 5 months, the advantage is stressed, of the procedure which, solving indirectly the fracture, protects the tibial focus, already poorly irrigated and susceptible to pseudarthrosis in thi;s type of location.

Fibula↗
PubMed1996

Functional outcome of patients with salvageable limbs with grades III-B and III-C open fractures of the tibia.

Numerous reports list predictive criteria to determine whether Gustilio-type tibial III-B and III-C fractures of the tibia are salvageable. What is lacking are long-term reports of comprehensive functional outcome of these severe injuries. We evaluated the functional outcome of patients with our own seven-scale score. Fifty-four patients with 57 types III-B (n = 41) and III-C (n = 16) open tibial fractures sustained between 1980 and 1989 were recalled for evaluation. There were 45 men and 9 women (average age, 28.4 years; range, 4-68 years). Follow-up periods averaged 48.2 months (range, 12-116 months). Salvage rate for the III-B fractures was 75% (n = 31) and for the III-C fractures 37% (n = 6). We conclude that the functional score is a simple and complete method for assessing the functional outcome of patients undergoing limb salvage procedures.

Activities of Daily Living↗
PubMed1998

[Isolated coracoid fracture--open reposition and osteosynthesis--report of 3 cases].

UNLABELLED: Usually coracoid-fractures are "chain-injuries" in association with complex shoulder injuries. Isolated fractures of the coracoid process are uncommon. In the literature there is no consensus about the treatment. The conservative method is generally advocated. For better recognizing the particularities of coracoid-anatomy and fracture-analysis we performed dissections on cadaver shoulders and also evaluated a useful radiologic technique for diagnosis. Between 1995 and 1997 three patients with isolated displaced coracoid-fractures had open surgical repair. The postoperative course was very good in all three cases with complete recovery of shoulder function. DISCUSSION: We believe that isolated coracoid-fractures with infero-lateral dislocation and loss of function should sustain open reduction and internal fixation with functional after treatment.

Adolescent↗
PubMed1998

[Primary shortening--secondary lengthening. A new treatment concept for reconstruction of extensive soft tissue and bone injuries after 3rd degree open fracture and amputation of the lower leg].

The main problem in major limb replantation--especially of the lower extremity--is an extensive bone- and soft-tissue loss. The traditional replantation concept tries to preserve the initial limb length; only a small shortening is accepted. To avoid a more extensive shortening, often insufficient debridement at the time of replantation is carried out. After successful revascularisation, bone and soft-tissue defects will be reconstructed according to the principles of staged reconstruction. Especially segmental nerve defects of more than one major peripheral nerve and severe skin and muscle loss necessitate extensive secondary grafting procedures. This often leads to a prolonged hospitalisation and a high complication rate. In 1951, Lorenz Böhler described the deliberate extremity shortening as a method of therapy in segmental combined bone-soft-tissue defects of the extremities. No additional surgical procedure were necessary to treat the soft tissue defect. A functional but shortened extremity was the result. With Ilizarov's principle of callus distraction he proved in an extensive experimental and clinical study the possibility to lengthen extremities without functional damage up to 20 cm. A new reconstruction concept--"concept of primary shortening with secondary limb lengthening"--for the treatment of amputation and/or amputation-like injuries was created by combining both principles mentioned above. At the time of replantation (reconstruction), deliberate shortening is carried out in order to reduce soft-tissue and/or bone defect or to enable primary nerve repair. Moreover, the aggressive debridement leads to a reduction of the local complication risk (wound healing disturbance, infection) and the potential systemic complications (crush-syndrome, ischemia-reperfusion-syndrome) after revascularisation of a large tissue bloc. Six to twelve months after replantation, secondary limb lengthening is started using an external or internal (= programmable intramedullary nail) distraction device. Since 1985, twelve patients (six macroamputations and six third-degree open fractures of the lower leg) have been treated using the "concept of primary shortening with secondary limb lengthening". Indications, operative technique, and results are shown and discussed, comparing this new concept to the traditional "concept of staged length-reconstruction" with extensive free tissue reconstruction and secondary nerve grafting.

Adult↗
PubMed2001

Once daily high-dose gentamicin to prevent infection in open fractures of the tibial shaft: a preliminary investigation.

BACKGROUND: Cephalosporin and aminoglycoside antibiotics are currently recommended for infection prophylaxis in high-energy open tibial shaft fractures. We evaluated cephalosporin in conjunction with once daily high-dose gentamicin as prophylaxis against infection in Gustilo types II and III open tibial shaft fractures. METHODS: Sixteen patients were identified in whom once daily gentamicin dosing was used as part of an antibiotic prophylaxis regimen in patients with types II and III open tibial shaft fractures. Cefazolin (1 g) and gentamicin (5 mg/kg) were given before operation. Antibiotic therapy was continued for 48 hours after definitive wound closure. Monitoring for gentamicin toxicity consisted of blood urea nitrogen (BUN) and creatinine levels, gentamicin trough levels, and a daily query for signs of prodromal ototoxicity. RESULTS: Average time to fracture union was 8 months. One superficial and two deep infections were observed. No patient showed signs of nephrotoxicity or ototoxicity. CONCLUSIONS: Our investigation suggests that this dosing regimen might be safe as prophylaxis against infection in open tibial shaft fractures and that it warrants further study.

Adolescent↗