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PubMed2006

Calcaneal fractures: indirect reduction and external fixation.

BACKGROUND: The current treatment of displaced intra-articular calcaneal fractures has been surgical fixation. The objective of this study was to evaluate the use of indirect reduction with Ilizarov external fixation as a viable alternative in the surgical treatment of certain calcaneal fractures. METHODS: Thirty-one patients with 33 fractures of the calcaneus (Sanders types II, III, and IV) were treated using small wire circular external fixation. A limited percutaneous plantar skin incision was used to improve reduction of the posterior facet. Fractures were evaluated by preoperative CT scans and classified by an independent observer. Patients were evaluated by physical examination as well as by the AOFAS hindfoot score questionnaire. Followup ranged from 6 months to 4 years. RESULTS: The average AOFAS score for 18 patients available for examination was 66 (42 to 92). The average score increased to 74 for patients with more than 10 months followup and to 77 for patients with isolated calcaneal fractures. Open fractures also had early debridement and soft-tissue coverage; no deep infections were seen in this subgroup. There were 11 complications, including nine superficial pin track infections, one superficial skin necrosis under an area of fracture blister, and one deep infection in a diabetic smoker with severe hemorrhagic fracture blisters. All superficial infections responded to local pin or wound care and oral antibiotics. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done. All open fractures healed and maintained soft-tissue coverage. CONCLUSIONS: Indirect reduction and external fixation is a viable surgical alternative for intra-articular calcaneal fractures. Particularly favorable results were obtained in open fractures when soft-tissue reconstruction also was done. Advantages include shorter time to surgery, immediate weightbearing, minimal invasiveness, few serious wound problems, and no residual hardware. Disadvantages include technical difficulty, incomplete reduction of fracture fragments, and the need for secondary surgery (fixator removal).

Adult↗
PubMed1997

The unreamed tibial rod in open tibial fractures.

BACKGROUND: Open tibial fractures may be managed surgically by either external fixation or the intramedullary rod. If a rod is used, the delayed removal of the locking screws has been advocated to enhance fracture healing. The aim of the present study was to report the results of closed unreamed locked tibial rods in open fractures and evaluate the effect of locking screw removal. METHODS: Fifty-one patients with open tibial fractures were treated by debridement, intravenous antibiotics, soft-tissue coverage and closed, unreamed, locked intramedullary rods. Forty-six patients were available for review at an average of 13.7 months after surgery. RESULTS: Union occurred at a mean of 240 days (168.1-312.3 CI). Five (10.8%) patients required bone grafting (two required a bone graft alone, three with exchange rods). Deep infection occurred in three (6.5%) cases, and malunion occurred in seven (15.2%) cases. Locking screw failure occurred in five (11%) cases. There was no significant association between removal of the locking screws, injury type and time to union when comminution was controlled for (P = 0.54). CONCLUSIONS: These results compare favourably to other methods of treatment for open fractures and suggest that removal of locking screws does not alter the time to union.

Bone Screws↗
PubMed1997

Long-term outcomes in open pelvic fractures.

BACKGROUND: Open pelvic fractures represent one of the most devastating injuries in orthopedic trauma. The purpose of this study was to document the injury characteristics, complications, mortality, and long-term, health-related quality of life outcomes in patients with open pelvic fractures. METHODS: The trauma registry at an adult trauma center was used to identify all multiple system blunt trauma patients with a pelvic fracture from January of 1987 to August of 1995 (n = 1,179). Demographic data, mechanism of injury, and fracture type were determined from hospital records. Short-term outcome measures included infectious complications, mortality, and length of stay in hospital. Long-term outcomes of survivors were obtained by telephone interview using the SF-36 Health Survey and the Functional Independence Measure. RESULTS: Open pelvic fractures were uncommon, occurring in 44 patients (4%). Patients with open fractures were about 9 years younger, on average, than patients with closed fractures (30 vs. 39, p < 0.001). Similarly, patients with open fractures were more likely to be male (75 vs. 57%, p < 0.02), more likely to have been involved in a motorcycle crash (27 vs. 6%, p < 0.001), and more likely to have an unstable pelvic ring disruption (45 vs. 25%, p < 0.001). Open pelvic fracture patients required more blood than closed pelvic fracture patients, both in the first day (16 vs. 4 units, p < 0.001) and during the total hospital admission (29 vs. 9 units, p < 0.001). Five patients with perineal wounds did not receive a diverting colostomy; in turn, these individuals had a total of six pelvic infectious complications (one abscess, two with osteomyelitis, and three perineal wound infections). Overall, 11 patients died, six patients were lost to follow-up, and 27 were long-term survivors (mean duration of 4 years). Chronic disability was common after a pelvic fracture, with problems related to physical role performance and physical functioning, and was particularly severe after an open pelvic fracture (p < 0.05 for both as measured by the SF-36). CONCLUSIONS: Patients with open pelvic fractures often survive, need to be treated with massive blood transfusions, and often require a colostomy. They are frequently left with chronic pain and residual disabilities in physical functioning and physical roles, and many remain unemployed years after injury.

Activities of Daily Living↗
PubMed1995

Significance of fracture gap in open tibial fracture.

The healing pattern of medial and lateral cortical gap in open transverse or short oblique tibial fractures were retrospectively reviewed in 2 groups; In group A, 16 patients were treated by Judet external fixator in rigid mode. In group B, 6 patients were treated in biocompressive mode, which allowed predominantly longitudinal axial motion. The characteristic healing pattern in group A was gap healing without or with minimal periosteal callus. The healing time and time for consolidation per 1mm gap were significantly longer in medial cortices than lateral ones (p < 0.036, p < 0.024 respectively). In group B, the fractures were healed with periosteal callus. There was no difference in the healing time and the time for consolidation per 1mm gap between the two cortices. The consolidation time per 1mm gap in the medial cortices was significantly longer in group A than group B (p < 0.020). The longitudinal axial motion in open transverse tibial fractures seems to shorten the healing time effectively in the medial cortex.

Adolescent↗
PubMed2006

Treatment of inherently unstable open or infected fractures by open wound management and external skeletal fixation.

OBJECTIVES: To assess the use of external skeletal fixation with open wound management for the treatment of inherently unstable open or infected fractures in dogs. METHODS: A retrospective review of 10 cases. RESULTS: Fracture stabilisation and wound management required only a single anaesthetic, and despite the challenging nature of these injuries, the final outcome was acceptable or good in every case. However, minor complications associated with the fixator pins were quite common, and two dogs developed complications which required additional surgery. CLINICAL SIGNIFICANCE: Open management of wounds, even when bone was exposed, proved to be an effective technique, and external skeletal fixators were usually effective at maintaining stability throughout an inevitably extended fracture healing period.

Animals↗
PubMed2026

Fracture-related infection following open forefoot fractures caused by dropped objects.

INTRODUCTION: This study evaluated the rate of fracture-related infection (FRI) of open forefoot fractures caused by dropped objects, and examined associations of treatment characteristics, including intravenous and oral antibiotics and operative debridement, with FRI. METHODS: Patients aged 18-80 years who sustained an open metatarsal or phalanx fracture caused by a dropped object between January 2021 and June 2024 were retrospectively identified from two Level 1 trauma centers. The primary outcome was FRI, determined based on the FRI consensus criteria. FRI rates were compared between those who underwent irrigation and debridement (I&D) at bedside versus in the operating room, and between those who received oral versus intravenous (IV) antibiotics. Patient characteristics were also analyzed to determine host factors associated with FRI. RESULTS: A total of 86 patients (median age 41 years [IQR: 29-56], 58% male) were included. Eighty-five patients (99%) received antibiotics, 31 (36%) of whom received intravenous antibiotics. Sixty-six patients (77%) received an I&D at presentation, 57 (66%) at bedside and 9 (10%) in the operating room. Thirteen patients (15%, 95% CI: 8.3%-24%) developed FRI. No significant difference in FRI rate was found between patients who underwent I&D at bedside versus in the operating room (12% versus 11%, p&#x202f;>&#x202f;0.99). Among patients who did not undergo I&D in the operating room, no significant difference in FRI rate was found between patients who received oral versus IV antibiotics (17% versus 13%, p&#x202f;=&#x202f;0.74). Insulin-dependent diabetes was associated with an increased risk of FRI (60% versus 12%, p&#x202f;=&#x202f;0.02). CONCLUSIONS: In this cohort, one in seven patients developed FRI. No statistically significant differences in FRI rates were observed by I&D setting (bedside versus operative) or antibiotic route (oral versus IV), including in a subgroup analysis excluding patients treated with operating room I&D. These findings are limited by sample size and potential treatment selection bias and should not be interpreted as evidence of equivalence. Management should be individualized based on clinical judgement, resource availability, and patient factors. These findings can help guide the management protocols for "dropped objects" open forefoot fractures presenting to urgent care and the emergency department. LEVEL OF EVIDENCE: Therapeutic Level III.

Humans↗
PubMed1995

A sequential protocol for management of severe open tibial fractures.

Fifty consecutive open fractures of the tibia, including 22 Grade IIIB and 4 Grade IIIC, were treated using a protocol of debridement, immediate wound coverage, and intramedullary nailing. Fasciocutaneous flaps were used extensively to cover areas of exposed bone. The severity of the soft tissue injury dictated the timing of definitive fixation. Fracture location determined implant selection and nailing technique. Patients were observed for an average of 21 months. Ninety-eight percent of the fractures united < 6 months postoperatively. There was 1 infection (2%), 2 malunions (4%), and 1 case of partial flap necrosis. Locking screws broke in 1 patient (2%); the fracture united with < 5 mm of shortening. Immediate postdebridement wound coverage, and intramedullary nailing after reconstruction of the soft tissue envelope facilitate fracture healing in these complex open injuries. Intramedullary nailing can be performed safely to include all grades of open tibial fractures from the proximal to distal metaphysis.

Adolescent↗
PubMed1997

Treatment of a large segmental bone defect with allograft and autogenous bone marrow graft.

Management of segmental bone defects is a challenge to orthopedic surgeons. We report a 23-year-old man who sustained segmental bone loss of 9 cm in length in his left femur due to an open fracture. Open reduction and internal fixation with a 95 degrees angle blade plate and screws, supplemented with a composite of two femoral head allografts and a graft of 100 mL of autogenous bone marrow, was performed 3 weeks after the injury, when the soft tissues had healed. The postoperative rehabilitation program included delayed weight bearing (crutches for 3 months), a limited early range of motion of the left knee, and quadriceps muscle exercise. Callus bridging was noted on x-ray films 3 months postoperatively. Clinical and radiographic union were noted 6 months after the surgery. We suggest that this new and simple method can be applied to successfully treat segmental bone loss of more than 6 cm in length.

Adult↗
PubMed1978

Open reduction of nasal fractures.

Open reduction of nasal fractures has been defined and discussed from a clinical standpoint. Specific advantages of the procedure are mentioned with the suggestion that perhaps more of these procedures should be performed. Reference is made to the authors' series of 788 cases, with analysis of type of injury, age group, and procedure performed.

Adult↗
PubMed2001

Bacteriological study and its role in the management of open tibial fracture.

Sixty percent of open fracture wounds are contaminated at the time of injury. Despite that, the necessity for sequential multiple cultures and sensitivity studies for open fractures and their interpretation are still controversial. Predebridement, intraoperative, postoperative swabs and swabs in established infection for culture and sensitivity study were taken in 33 open tibial fractures over a 6 months period. 39.3% of predebridement swabs grew bacteria with the majority yielding gram-positive organism. None of the patients developed infection with similar organisms. 24.2% of the postoperative swabs grew bacteria, of which 75% were gram-negative. 50% of the patients with positive postoperative swabs developed infection. Thus, the role of sequential multiple cultures and sensitivity studies are not helpful in management of open fracture.

Adolescent↗