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At least 919 records · Page 51Linked to original sources
PubMed1994

[Reducing the risk of infection by use of an unreamed intramedullary nail in open tibial fractures].

An intramedullary stabilisation with an unreamed tibial nail (UTN) was carried out in 75 patients suffering from first (n = 45) and second (n = 30) degree open fractures. In 23 cases (8 of which had a second degree and 15 a third degree open fracture) the treatment regime was changed from external fixation (EF) to an UTN. The results were compared with 112 patients with first degree open tibial fractures treated with a reamed tibial nail (RTN). A change from EF to RTN was carried out in 93 cases (21 patients had a first degree, 55 a second degree and 17 patients a third degree open fracture). The rate of infection seen in open fractures was reduced by using an UTN for the tibia (4.5% using RTN versus 1.3% using UTN in primary implantation; 6.5% versus 4.3% in case of changing from EF to tibial nailing). The UTN does not disturb the healing of the fracture and there is no increased risk of axis deviation.

Adolescent↗
PubMed1991

Unilateral external fixation until healing with the dynamic axial fixator for severe open tibial fractures.

One hundred one cases of open tibia fractures were treated until healing with a unilateral external fixation device that permits fracture site compression with weight bearing. There were 38 type II and 63 type III (24 IIIA, 33 IIIB, six IIIC) open fractures. A standard protocol was followed including irrigation and debridement and, when necessary, flap coverage (19 cases) and bone grafting (31 cases). Fixators were applied at the first debridement and removed when the fracture was healed. All patients were permitted early partial weight bearing and progressed to full weight bearing with fixator dynamization. Ninety-six cases healed in the fixator (12-50 weeks; average, 24.6). Three of the five failures were associated with screw complications. Five patients required screw changes and 29 required oral antibiotic therapy for screw complications. Ninety-five percent of healed cases had angulation of less than 10 degrees (in any plane). There were only six fracture site infections during the course of treatment. Dynamic axial fixation may be applied at the first debridement and be used until healing in severe open tibia fractures. Change of the fixator to another treatment method is not required.

Adolescent↗
PubMed1988

External fixation of complex open humeral fractures.

Seven cases of complex open humeral fractures treated by external fixation are reported. The external fixation allowed the associated injuries to nerves, arteries and soft tissues to be adequately treated. Four cases developed non-union and of these, three cases treated by bone-grafting and plating united, but the one case treated by intramedullary nail without bone-graft did not unite. Frame construction and pin placement are discussed. The recommended plan for treatment of these fractures is initial external fixation until adequate soft tissue healing is achieved and sepsis controlled. Then early bone-grafting and plating is advocated if there is no progressive fracture healing. The problems and advantages encountered in the use of external fixation are also described.

Adult↗
PubMed1986

Infectious morbidity in extremity fractures.

To review infectious morbidity in extremity fractures, 265 patients with 280 open fractures and 573 patients with closed fractures requiring open reduction and internal fixation (ORIF) were reviewed. Among open fractures, 32 (11%) became infected. Significantly fewer infections occurred in open fractures secondary to gunshot wounds (p less than 0.01) and in the upper extremity regardless of cause (p less than 0.05). Preventive preoperative antibiotics did not appear to affect infection rates. Open fracture infections were consistently with hospital-acquired organisms, and these were consistently resistant to the preventive antibiotic employed. Closed fractures had only 18 (3%) infections after ORIF. Preoperative antibiotics did reduce infection rates compared to rates in patients with no preoperative systemic antibiotics (p less than 0.05). Pathogens in ORIF patients showed a greater preponderance of Staphylococci. In conclusion, preventive antibiotics were only effective in the prevention of infection in the ORIF patients. Open fracture patients consistently develop infections with hospital-acquired pathogens, suggesting that contamination after hospitalization rather than at the time of injury is a major factor.

Anti-Bacterial Agents↗
PubMed1997

The orthopedic and social outcome of open tibia fractures in children.

To determine whether the accepted principles of management of open tibia fractures apply to children, 40 consecutive open fractures of the tibial shaft in skeletally immature patients were retrospectively reviewed. Attempts were made to evaluate the functional and social impact of open tibia fractures in children. All open fractures were initially treated by rapid irrigation and debridement which was repeated every 48 hours until soft tissues stabilized. The average age was 10.1 years and average follow up was 26 months (range: 18 to 84). There were 16 grade I, 10 grade II, and 14 grade III open fractures. The grade III fractures were further subdivided into 6 grade IIIA, 7 grade IIIB, and 1 grade IIIC. The average time to union was 7.5 and 11.0 weeks in the grade I and II fractures respectively, with no infections and no delayed unions. In grade III fractures, the average time to union was 15 weeks, with 1 infection and 3 delayed unions. Bone grafting using autogenous iliac crest was performed on 2 patients. The children surveyed missed an average of 4.1 months of school and 33% had to repeat a year. Twenty-five percent of the children complained of nightmares involving the events of the accident. Chronic pain despite solid union was found in 30% of patients. Forty percent of those surveyed (7 grade III fractures) complained of a limp. The low incidence of soft tissue complications and infections in the study population supports applying in children the same basic soft tissue management principles of open fracture treatment as used in adults. While bone stabilization options are limited in children, the rate of successful union without adjunctive bone grafting is much higher than that of adults treated under similar protocols. Routine early iliac crest bone grafting is unnecessary. The prevalence of gait abnormality despite fracture union should be taken into account during the patient's rehabilitation. The extensive time missed from school and resulting scholastic setback should not be underestimated.

Adolescent↗
PubMedDate not supplied

Management of open tibial fractures at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Open fractures of tibia are usually caused by high-energy injury. Management of such injuries requires care of contaminated soft tissue injury involving skin, muscles and neurovascular structures. Treatment of fracture, which is badly comminuted and potentially contaminated, is always a problem. While limb salvage is the initial aim, medium and long-term problems with soft tissue cover, infection and union are all too common and result in serious disability. METHODS: 32 open grade-III tibial fractures were treated with AO (Arbeitsgemeinschaft fur Osteosynthesefragen) tubular external fixator. The management and outcome were reviewed and tabulated. RESULTS: One out of 32 required primary amputation due to delayed vascular repair. The remainder received standardized wound care consisting of surgical debridement and delayed closure of wound. Once the soft tissue envelope healed and fracture was sticky external frame was removed and patella tendon bearing cast applied. In selected cases internal fixation was done (n = 8, in 5 intramedullay nailing and in 3 plating). Nineteen cases were treated in PTB cast and 4 cases in external fixation till union. Deep infection rate was 13% and pin tract infection 10%. In 31 cases union was achieved in 32 weeks (24 weeks to 62 weeks).

Adult↗
PubMed1983

Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results.

Thirty-six Types III and IIIa open fractures of the tibial shaft are presented with a treatment protocol based on early, aggressive wound management and fracture coverage utilizing muscle, myocutaneous, or free flap techniques. There were five amputations, seven deep infections, three nonunions, and no cases of chronic osteomyelitis in the series. The criteria for inclusion in the series were definitive wound coverage by 30 days after injury and end-result records including time of union. Wound coverage was classified as early (0-7 days) or late (8-30 days). Major and minor wound healing disturbances were found in 20.8% of the early and 83.3% of the late groups, with mean union times of 4.0 months and 6.4 months, respectively. Extensive and serial debridements, coverage within five to seven days, and early bone grafting produce a viable soft tissue envelope and a favorable mesenchymal milieu for the healing of complex open fractures. This significantly improves end results with respect to union, tissue loss from infection, healing time, and cost of hospitalization and rehabilitation.

Debridement↗