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Thomas B, Hackenberg RK, Krasniqi D, Eisa A, Böcker A, Gazyakan E, Bigdeli AK, Kneser U, Harhaus-Wähner L. [Modern concepts of interdisciplinary extremity reconstruction in open fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:469-480. [PMID: 38739196 DOI: 10.1007/s00113-024-01437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/14/2024]
Abstract
The orthoplastic approach involves the collaboration of orthopedic/trauma surgeons, vascular surgeons and reconstructive microsurgeons. In cases of complex limb fractures, the aims are to optimize blood flow, restore bone stability, reconstruct soft tissue defects, and enhance function and sensitivity. The early administration of antibiotics and a timely, high-quality debridement after initial interdisciplinary assessment are carried out. This is followed by fracture stabilization and temporary wound coverage in order to plan the definitive interdisciplinary procedure. This includes definitive osteosynthesis and soft tissue reconstruction, using local tissue transfer if feasible, or free tissue transfer in cases of extensive trauma zones. The orthoplastic approach allows for faster definitive stabilization, fewer operations, shorter hospital stays, lower complication and revision rates, higher cost-effectiveness and improved long-term function.
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Affiliation(s)
- Benjamin Thomas
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland.
| | - Roslind K Hackenberg
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Demir Krasniqi
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Amr Eisa
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Arne Böcker
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Emre Gazyakan
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Amir K Bigdeli
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Ulrich Kneser
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Leila Harhaus-Wähner
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
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Sreedharan S, Bruscino-Raiola F, Lew P, Ling Y, Ferris S. Bone union and mobility outcomes for reconstructed open tibial fractures: a plastic surgical experience from a major trauma center. Front Surg 2024; 11:1348991. [PMID: 38362457 PMCID: PMC10867201 DOI: 10.3389/fsurg.2024.1348991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The goal in open tibial fracture management is to achieve a united tibia in an extremity that allows pain free mobilization. The objective of this study was to assess factors that lead to this functional outcome in lower limb reconstruction, from a plastic surgical perspective. Materials and methods The Plastic and Reconstructive Surgery lower limb database at a tertiary trauma hospital was searched for open tibial injuries from February 2015 to March 2020. The nature and severity of injury, timing and details of all operations including reconstructions were collected prospectively. Mobility including gait aids, pain, and complications were retrospectively collected. Union was assessed in two ways, depending on fracture location. Metaphyseal and diaphyseal tibial fractures were provided mRUST scores (union defined as RUST > 13) and epiphyseal tibial fractures were categorically classified as "united" or "non-union" by two independent radiologists. Results During the five-year study period there were 148 open leg injuries in the database. Twenty-one patients underwent a primary amputation due to severity of their initial injury. One hundred patients underwent primary limb salvage. Sixty-one patients in the limb salvage group achieved primary tibial union with a mean follow-up time of 19.4 months post injury. Twenty-three additional patients were confirmed to subsequently unite. Patient who achieved union were more likely to mobilise without gait aids. Discussion In this study definitive external fixation and soft tissue infection were both associated with higher rates of non-union. Longer times to soft tissue reconstruction was not associated with an increase in acute soft tissue complications. More importantly bone union, pain and mobility did not decline. After undertaking a primary limb salvage pathway for 100 patients, the ultimate tibial fracture union rate was 84% and the confirmed ambulation rate was 96%.
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Affiliation(s)
| | | | - Philip Lew
- Department of Radiology, The Alfred, Melbourne, VIC, Australia
| | - Yuan Ling
- Department of Radiology, The Alfred, Melbourne, VIC, Australia
| | - Scott Ferris
- Plastic, Hand and Faciomaxillary Surgery, The Alfred, Melbourne, VIC, Australia
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Cheng KY, Yang CY, Liu SC. Assessing the risks of children with preoperative comorbidities undergoing comminuted fracture surgery. Front Pediatr 2023; 11:1118954. [PMID: 36891228 PMCID: PMC9986599 DOI: 10.3389/fped.2023.1118954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Comminuted fractures are characterized by bones broken in at least two places, destabilizing the bone and requiring surgery. Children whose bones are still developing and maturing tend to have a higher risk of sustaining comminuted fractures as the result of trauma. Trauma is a major cause of death in children and constitutes a major issue in orthopedics because of the unique properties of children's bones compared to adult bones and the associated complications. Methods This retrospective, cross-sectional study aimed to refine the association between comorbid disease and comminuted fractures in pediatric subjects using a large, national database. All data were extracted from the National Inpatient Sample (NIS) database from 2005 to 2018. Logistic regression analysis was used to evaluate associations between comorbidities and comminuted fracture surgery and between various comorbidities and LOS or unfavorable discharge. Results A total of 2,356,483 patients diagnosed with comminuted fractures were selected initially, of whom 101,032 patients aged younger than 18 years who underwent surgery for comminuted fractures were included. Study results suggest that patients with any comorbidities undergoing orthopedic surgery for comminuted fracture appear to have longer LOS and a higher proportion of discharge to long-term care facilities. Discussion Almost all comorbidities were significantly associated with poor in-hospital outcomes and longer LOS. The analysis of comminuted fractures in children may provide useful information to help first responders and medical personnel evaluate and manage comminuted fractures appropriately.
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Affiliation(s)
- Kai-Yuan Cheng
- Department of Orthopedics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yu Yang
- Department of Orthopedics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shih-Chia Liu
- Department of Orthopedics, MacKay Memorial Hospital, Taipei, Taiwan
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Kalbas Y, Klingebiel F, Pape HC. Antibiotic coated nails: Rationale, development, indications and outcomes. J Orthop Surg (Hong Kong) 2022; 30:10225536221118521. [PMID: 36545939 DOI: 10.1177/10225536221118521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The concept of antibiotic-coated implants, mainly coated intramedullary nails, has become increasingly used for the treatment of fracture related infections. After a long period of hand-made implants, commercially fabricated implants combine several benefits. Antibiotic-coated nails constitute a solid treatment option for unstable diaphyseal infections with fractures or non-unions. They release high concentrations of antibiotics locally, while retaining reduction and providing axial stability. This review aims to provide an overview about the background, the development, the indications, the treatment strategies and the outcomes of antibiotic-coated intramedullary nails.
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Affiliation(s)
- Yannik Kalbas
- Department of Trauma Surgery and Harald-Tscherne Laboratory, 27243University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Felix Klingebiel
- Department of Trauma Surgery and Harald-Tscherne Laboratory, 27243University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery and Harald-Tscherne Laboratory, 27243University of Zurich, University Hospital Zurich, Zurich, Switzerland
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