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At least 937 records · Page 52Linked to original sources
PubMed1992

Open tibial fractures: current orthopaedic management.

Treating the spectrum of bone and soft-tissue injuries that can accompany open fractures of the tibia requires experience and judgment. It appears that the non-reamed interlocking nail can safely and reproducibly stabilize most low-energy and selected high-energy open fractures of the leg. Severe open tibial fractures require a staged reconstructive protocol using external fixation as the method of bony stabilization. Differentiation between the requirements of individual injuries remains the key to successful treatment.

Anti-Bacterial Agents↗
PubMed1984

The management of type III open tibial fractures.

In extensive type III open tibial fractures, limb salvage is considered worthwhile when there is good distal circulation and nerve function. The use of the external fixator has revolutionized the management of skin and soft tissues. However, the subsequent morbidity is still high. A retrospective study of 17 cases is analysed: the amputation rate was 6 per cent, delayed union 60 per cent, infected non-union 30 per cent and mal-union 40 per cent. The final functional result was good in 13 per cent of cases, satisfactory in 30 per cent, fair in 30 per cent and poor in 27 per cent. All patients preferred a functional limb to a prosthesis. The technique of using external fixation and the subsequent management are discussed. To improve the result, we recommend perfect alignment, fixation of the fracture with semi-rigid external fixation and early cancellous bone grafting for comminuted fractures and bone loss. Secondary internal fixation using implants is not advisable. A radical approach is necessary in infected ununited fractures. This includes excision of dead and contaminated tissue and the insertion of gentamicin methyl methacrylate bead implants. Although the complication rate is high and the rehabilitation period is prolonged, the main aims of limb salvage, viz. to retain a functional leg, are largely fulfilled.

Adolescent↗
PubMed1998

[Open pelvic fracture--an indication for laparotomy?].

Open pelvic fractures are rare and account for 1-5% of all pelvic fractures. Mortality rates of 50% and even more have been reported. Bleeding and septic complications are the major causes of death. In our retrospective study from 1974 to 1996 the data of 40 patients were analyzed. Five patients died (12.5%); 28 survivors could be investigated with a mean follow-up of 10 years. It is concluded that the comparably low mortality rate is due to a standardized treatment protocol. The main principles of management are emergency stabilization of the unstable pelvis and early laparotomy.

Adolescent↗
PubMed1994

Delayed unions and nonunions of open tibial fractures. Correlation with arteriography results.

To investigate the importance of arterial integrity in tibial fracture healing, the authors retrospectively assessed prognosis as a function of arterial injury in a large series of tibial fracture patients. The records of 114 patients who were treated for an open fracture of the tibia at a San Francisco hospital between 1981 and 1991 were selected for review; in each case, the injury had been caused by a blunt trauma, and arteriography had been performed to evaluate a suspected arterial injury in the ipsilateral extremity. Sixty-two patients had had a normal arteriogram and 52 had demonstrated occlusion of one or two of the three arteries that supply the foot. The group of patients who had demonstrated arterial occlusion had a significantly greater incidence of delayed union or nonunion (24 of 52 compared with ten of 62) and notably more cases of osteomyelitis (nine of 52 compared with four of 62); when the patients with osteomyelitis are excluded, the difference between the groups is still significant. This study is the first that indicates that patients with open fractures of the tibia who demonstrate arterial occlusion in their ipsilateral extremity may be more prone to delayed union or nonunion. More vigilant follow-up evaluation may therefore be warranted in such patients to better anticipate the need for exchange rodding or bone grafting.

Adolescent↗
PubMedDate not supplied

Aeromonas hydrophila infection complicating an open tibial fracture. A case report.

Aeromonas hydrophila is a gram-negative bacterium that commonly inhabits soil and stagnant water. On extremely rare occasions, the organism can cause an aggressive, rapidly spreading, necrotizing infection in humans. The systemic signs of high fever, tachycardia, and elevation of the white blood cell count appear within 24 hours of wound contamination. If the wound is obscured by a cast, these signs erroneously may be attributed to a respiratory problem, e.g., atelectasis or fat metabolism. The organism is not usually sensitive to penicillin or cephalothin. The key to success for saving the extremity appears to be early aggressive debridement. Early diagnosis requires prompt wound inspection as soon as clinical signs of sepsis appear.

Adult↗
PubMed1998

[Osteosynthesis with elastic nailing for treatment of tibial fracture].

Results of treatment of 163 tibial fractures in 47 females and 116 males aged 15-76 operated with closed elastic intramedullary osteosynthesis are presented. A bundle of universal intramedullary nails preshaped depending on fracture pattern served for osteosynthesis in 144 closed fractures, 18 open fractures of first degree and 1 second degree open fracture. In all cases but one fracture healed. Late results were assessed in 70 cases. There were 46 good results, 23 fair and 1 poor result. Simple surgical technique, good stability, stimulating of bone healing by compression and minor risk of infection constitute advantages of this method.

Adolescent↗
PubMed1988

Open tibial fractures treated with Hoffmann external fixation.

Thirty-two open fractures of the tibial shaft were treated with external fixation between 1973 and 1981. Early amputation was necessary in one patient. In the remainder, including 14 with extensive soft-tissue lesions, wound healing was obtained within 18 weeks, and the median time until full weight bearing without pain was 32 weeks (range 8-60 weeks). Two deep infections healed during the observation period. Among 26 patients examined 1-9 years after the injury, the result was excellent in six, good in 11, fair in four, and poor in five patients (including the amputation). One fracture had not united during the observation period. Four poor results were due to the stiffness of the ankle and foot after compartment syndrome. In conclusion, alertness for early fasciotomy is necessary even in severe open tibial fractures. The external fixation should not be continued longer than the soft tissue and bone reconstruction make it necessary.

Adolescent↗
PubMed1996

Open reduction and internal fixation of type II intra-articular calcaneus fractures.

Open reduction and internal fixation of 23 type II calcaneus fractures in 21 patients was performed using a standard extended lateral approach. Average follow-up was 26 months (range, 12-47 months). The Creighton-Nebraska Health Foundation Assessment Score for Fractures of the Calcaneus was used to evaluate fractures. The average score was 91.4 (range, 80-100), which represented an excellent result. A series of 10 type II fractures treated with closed methods was also evaluated using the same evaluation methods. The average score was 70 (range, 60-84), which represented a fair result. There was a clear statistically significant superiority with type II calcaneus fractures treated with open reduction and internal fixation (P < 0.0001). We recommend type I calcaneus fractures (nondisplaced) be treated with closed methods, and type II calcaneus fractures (displaced) be treated with open reduction and internal fixation.

Adolescent↗