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At least 721 records · Page 40Linked to original sources
PubMed1995

Structural allografts for reconstruction of lower extremity open fractures with 10 centimeters or more of acute segmental defects.

Long-term results on the use of structural allografts (> or = 10 cm) to reconstruct large skeletal defects sustained during high-energy, open lower extremity fractures have not been reported. Eight patients are retrospectively reviewed at postallograft time periods ranging from 18 to 93 months. Two patients required reoperation for noninfectious causes, and each healed uneventfully. Four individuals developed infectious complications, but only one required complete allograft removal (amputation). The others remain infection free at follow-up. Using any of three different rating systems, excellent functional outcome results from this method of reconstruction in an otherwise exceptionally challenging extremity for limb salvage.

Adolescent↗
PubMed1987

[Sorption detoxication in the treatment of open fractures of the extremities complicated by purulent infection].

The article describes the authors' experience with the treatment of open diaphyseal and intra-articular fractures of bones of the upper and lower extremities complicated by purulent infection, in 126 patients sorption methods being used (hemosorption, enterosorption, application of sorbents on the wounds). Results of the treatment were studied in 120 patients within the period from 1 year to 6 years. Good results were obtained in 44 patients (36.7%), satisfactory--in 60 patients (50%), unsatisfactory--in 16 patients (13.3%).

Adolescent↗
PubMed1997

External fixation for severe open fractures of the humerus caused by missiles.

OBJECTIVE: To evaluate the use of external fixation of the humerus after missile injuries. DESIGN: Retrospective. SETTING: University medical center. PATIENTS: Twenty-six soldiers with twenty-six open Gustilo type III fractures. INTERVENTIONS: Immediate external fixation. MAIN OUTCOME MEASURES: Clinical, functional, social, and rehabilitation criteria were evaluated. RESULTS: Excellent in fourteen patients (61%), good in four (17%), fair in three (13%), and poor in two (9%). All fractures eventually healed. CONCLUSION: External fixation is the preferred initial treatment for stabilizing severe open missile fractures of the humerus. Its use, together with radical debridement of dead bone, has reduced the incidence of chronic infection and improved the prognosis of vascular repairs. As a result, the rate of morbidity and upper limb amputation has been reduced significantly, compared with our previous experience.

Adult↗
PubMed1978

The effect of antibiotics, primary and secondary closure on clostridial contaminated open fracture wounds in rats.

In a study of experimentally induced open tibial or femoral fractures in rats, after either closing or leaving the wounds open, the animals were given: no antibiotic, cephalothin (Keflin), or penicillin. The rats with wounds closed primarily and receiving no antibiotics had the highest mortality rate (11 of 25) from experimentally produced clostridial myonecrosis. The lowest overall mortality rate (5 of 99) was found in the penicillin-treated groups. The higher mortality rate in the femur fracture groups was probably because of the large muscle mass of the thigh. The importance of ideal anaerobic conditions for producing experimental clostridial myonecrosis is emphasized.

Animals↗
PubMedDate not supplied

[Personal experience in the care of open fractures using external fixation during the hostilities in Osijek and surrounding region].

In the period of aggression of the Federal Army and Serbian paramilitary forces on the City of Osijek and its surrounding, beginning in the summer of 1991, 4036 wounded were treated at the Department of Surgery, Osijek General Hospital. Extremity injuries were documented in 3889 patients, including 959 bone fractures. The majority of patients had wounds caused by highly destructive explosives filled with metal fragments of different shapes and dimensions, and having sharp and uneven edges. One hundred and forty wounded were treated by external fixators. In 102 patients this mode of fixation was applied for gun- and explosive-related long bone fractures of the lower extremities. External fixator for the upper and forearm fractures was used in 38 cases. During this period, different types of external fixators were used and experience in this work has been gained. Stability of both open and unstable bone fractures of the extremities, caused by explosive devices, has been obtained by the external fixation mostly in one plane, regardless of the type of external fixator used. The advantages of use of external fixators of the types Instrumentarija Zagreb 1 and 2 for the treatment of long bone fractures has been emphasized as well as the possibility of the subsequent corrections owing to the technical construction of the bone spike. The usefulness of the longitudinal bar of the AO/ASIF fixator for the healing of fractures of the upper leg with subsequent callus formation is also stressed. The same stability has been achieved by the CMC fixator. The external fixators of a type Zagreb 2 have been a satisfactory treatment for forearm fractures as well.(ABSTRACT TRUNCATED AT 250 WORDS)

Croatia↗
PubMedDate not supplied

Management of complex open fracture injuries of the midfoot with external fixation.

Ten patients (11 feet) with severe, high-velocity, open injuries to the midfoot were treated with uniplanar external fixation. The mean patient age was 38 years. Five wounds measured >10 cm, and 3 had extensive degloving of the foot extending into the lower leg. All had grossly comminuted fractures of the tarsal and metatarsal bones: 9 patients had a fractured cuboid; 6 had a fractured navicular; 7 had a fractured cuneiform; and all had metatarsal fractures. Lisfranc joint dislocations were present in 7 feet, and intertarsal dislocations were seen in 3 cases. Six patients underwent split-thickness skin grafting, and 1 required a myocutaneous flap. The average duration of fixator use was 9 weeks (range, 6-15 weeks). Clinically, patients were evaluated 1 year after fixator removal for any residual pain in the foot, ability to stand on tiptoe, presence of a limp, deformity of an arch, and range of motion at the ankle, subtalar, and metatarsophalangeal joints. Each parameter was graded as good, fair, or poor. All patients had sensate plantigrade feet, with 2 patients who experienced pain on weight bearing, 5 who had difficulty standing comfortably on tiptoe, and 2 who limped because of pain. Three patients exhibited flatfoot deformity, whereas 4 had cavus deformity. All demonstrated stiffness at the midfoot and restriction of subtalar and forefoot motion, with 5 also having restricted ankle motion. Radiographically, all fractures were healed at the time of follow-up; 4 were malunited, with 1 demonstrating ankylosis across the tarsometatarsal joint. These results suggest that crush injuries to the midfoot often result in persistent morbidity despite early comprehensive management with external fixation.

Adult↗
PubMed1988

Tips of the trade #3. Using a bone spreader for open fracture reduction.

The use of an accessory instrument in open reduction of long bone fractures is described. The long bone traction needed in the operating room for fracture reduction can be obtained using this method, eliminating the need for the customary pulling on the draped extremity. This technique has been used routinely for 35 years.

Fracture Fixation↗
PubMed1993

[Value of adjuvant local antibiotic administration in therapy of open fractures. A comparative analysis of 704 consecutive cases].

Seven hundred and four compound fractures--198 (28%) grade I, 259 (37%) grade II, 247 (35%) grade III (86 IIIA, 119 IIIB, 42 IIIC)--were treated in 590 patients between May 1983 and May 1989 at the University of Louisville. Of these fractures, 157 (22%, group 1) received systemic antibiotic prophylaxis only, whereas 547 (78%, group 2) were treated with additional local application of aminoglycoside beads (tobramycin). Comparison of factors (fracture grades, age, sex, fracture location, follow up) revealed no significant differences between the two groups. All fractures underwent timely irrigation, debridement and skeletal stabilization. In group 1, 52 wounds were primarily closed, 53 underwent delayed primary closure and 52 were left open. In group 2 283 wounds were primarily closed, 229 were managed with the bead pouch technique and 35 were adapted loosely (delayed closure). Forty-nine (6.96%) of the 704 compound fractures became infected (acute wound infection and/or chronic osteomyelitis). Group 1 showed an infection rate of 16.6% (26/157), group 2 a rate of 4.2% (23/547). The difference was statistically highly significant (P < 0.001). Comparison of the infection rates, whether on an acute or a chronic basis, showed that infection rates were lower in group 2 than in group 1 for all fracture grades. A statistically significant difference was established only for type IIIB fractures, where the wound infection rate was 39.1% (9/23) in group 1 and 7.3% (7/96) in group 2 (P < 0.001). The rate of chronic osteomyelitis was 26.1% (6/23) in group 1 and 6.3% (6/96) in group 2 (P < 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Open fracture of the leg with major cutaneous lesions. Imperative character of immediate closure and following possibilities of internal stabilization of the skeleton. Apropos of a continuous series of 20 cases].

The advantages of immediate wound closure in case of open leg wounds, as opposed to delayed repair or the use of greasy dressings, need no longer be proven. Indeed, modern plastic surgery technics have become quite ingenuous, reliable and applicable to most severe skin, lesions (type III as per Cauchoix-Duparc and so--called potential type III). These facts have been confirmed by a study of 20 cases including both types. Moreover, more and more often, immediate wound repair allows for external fixation replacement, typically by osteosynthesis, which is more advantageous from the viewpoint of fracture consolidation. Complications (namely infection rates) have not increased, which is an encouragement for the continued application of this method, which constitutes a departure from usual indications.

Adult↗
PubMed2005

A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation.

PURPOSE: To compare 2 methods of surgical treatment for displaced intra-articular fractures of the distal radius: open reduction and internal fixation with dorsal plating (Pi Plate; Synthes, Paoli, PA) versus mini open reduction with percutaneous K-wire and external fixation. METHODS: Patients with AO type C intra-articular distal radius fractures were randomized into 2 groups: open reduction and internal fixation and dorsal plating or external fixation and K-wires and mini-open reduction. Patients over the age of 70 years with any associated soft-tissue or skeletal injury to the same limb and pre-existing wrist arthrosis or disability were excluded from the study. Objective, subjective, and radiographic outcomes were assessed at 2 weeks, 4 to 6 weeks, 10 to 12 weeks, 6 months, and 1- and 2-year intervals. The minimum follow-up period was 6 months; the average follow-up period was 18 months. The principal outcome analyzed was the Disabilities of the Arm, Shoulder, and Hand score. Secondary outcomes included grip strength, range of motion, surgical procedure time, complications, and radiographic parameters. The groups were equal with respect to age, gender, fracture subtype, and number of workers' compensation cases. RESULTS: No significant difference was found in the Disabilities of the Arm, Shoulder, and Hand scores, our primary outcome. The dorsal plate group, however, showed a higher complication rate when compared with the external fixator group. The plate group had significantly longer tourniquet times when compared with the external fixator group. The plate group also had higher levels of pain at 1 year when compared with the external fixator group; however, this equalized after hardware removal. The external fixator group showed an average grip strength of 97% compared with the normal side and 86% in the dorsal plate group. CONCLUSIONS: At midterm analysis the dorsal plate group showed a significantly higher complication rate compared with the external fixator group; therefore enrollment in the study was terminated. The dorsal plate group also showed statistically significant higher levels of pain, weaker grip strength, and longer surgical and tourniquet times. Based on these results we cannot recommend the use of dorsal plates in treating complex intra-articular fractures of the distal radius.

Adult↗
PubMed2000

Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning.

Surgical management of two-part and three-part proximal humerus fractures is difficult and requires familiarity with more than one method of fixation. Poor bone quality, comminution, and the deforming forces of the rotator cuff on the tuberosities influence the choice of operative approach and fixation techniques. Closed reductions and percutaneous pinning offer the potential advantage of minimal soft-tissue dissection; however, good bone quality and minimal comminution are prerequisites. Selected two-part surgical neck fractures and valgus-impacted fractures lend themselves well to this technique. Open reduction and internal fixation is indicated in two-part surgical neck fractures with poor bone quality or extensive comminution, two-part greater tuberosity or lesser tuberosity fractures, and most three-part fractures. The choice of surgical approach is dictated by the fracture pattern and includes an extended deltopectoral approach and a superior deltoid-splitting approach. Fixation techniques are myriad and are dependent on the fracture pattern. Potential fixation methods include intramedullary rods, interfragmentary sutures or wires, and extramedullary plates and screws or blade plates. Successful results are predicated on obtaining adequate enough fixation to allow early passive motion. Results also are influenced by the quality of the reduction and patient compliance.

Bone Nails↗
PubMed1993

[Therapy of humeral head fracture. Open reposition and fixation with PDS pins].

Seven patients who sustained a displaced fracture of the capitulum humeri had been treated by surgery, using a volar approach and internal fixation with PDS pins. The advantage of this method is that by using the volar approach, the displaced capitulum could be reduced properly in its exact anatomical position. The internal fixation with PDS pins was solid enough to allow early postoperative movements. A second operation to remove any material was not necessary. In all cases the clinical and x-ray results have been excellent.

Adolescent↗
PubMedDate not supplied

Pediatric olecranon fractures: open reduction and internal fixation with removable Kirschner wires and absorbable sutures.

The authors present an original fixation technique for pediatric olecranon fractures that avoids reoperation to remove hardware as compared with the standard fixation technique with Kirschner wires and tension band wiring as advocated by the AO technique. The authors' technique uses two percutaneously placed Kirschner wires to fixate displaced transverse and oblique olecranon fractures. Prior to the insertion of the wires, the fracture is reduced through a standard open approach. Augmentation of the pin fixation is achieved with absorbable sutures. Six patients have been treated with this technique, with a mean follow-up of 13 months. No immediate complications have been noted; one patient has a loss of extension of 10 degrees at the elbow. Radiographic results are good, with no loss of reduction. This technique avoids the need for reoperation for hardware removal without compromising the quality of reduction.

Absorbable Implants↗
PubMed1998

The epidemiology of open long bone fractures.

Open long bone fractures occur with a frequency of 11.5 per 100,000 persons per year. They are more common in males and they have a bimodal age distribution. Open fractures of the tibial diaphysis are the commonest, but open femoral diaphyseal, distal femoral and proximal tibial fractures tend to occur in the most seriously injured patients. Lower limb open fractures are more severe than open fractures of the upper limbs. Not only is the soft tissue damage less in open upper limb fractures, but there are fewer associated musculoskeletal injuries.

Accidents, Traffic↗