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Geetala R, Zhang J, Maghsoudi D, Madigasekara A, Krkovic M. The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. Strategies Trauma Limb Reconstr 2024; 19:32-35. [PMID: 38752193 PMCID: PMC11091894 DOI: 10.5005/jp-journals-10080-1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Tibial osteomyelitis can follow open fractures with bacteria colonising the wound and persisting through biofilm and sequestrum formation. The treatment is complex, requiring eradication through debridement before limb reconstruction, for which the Taylor spatial frame (TSF) is one option. This study evaluates patient outcomes after reconstruction and identifies factors associated with post-operative complications. Materials and methods Fifty-one cases of tibial osteomyelitis were treated by the Ilizarov technique from 2015 to 2021 at a major trauma centre. Bacterial samples and treatment factors were assessed. Patient outcomes were complication rates and time to bony union. Complications were expressed as odds-ratios (OR) with 95% confidence intervals. Linear regression was used to assess factors associated with time to union. Results The mean follow-up was 24.1 months with the mean time to radiological union being 11 months. Post-operative complications were noted in 76.5% of patients with pin-site infections most common (52.9%), followed by fracture malunion (29.4%). Smoking was associated with increased fracture malunion (OR = 4.148, 95% confidence Interval [1.13-15.18], p = 0.031). The time to union was positively associated with complications, age and time to full weight-bearing (FWB). All other measured factors were found not significant. Conclusion Tibial osteomyelitis is treated reliably by debridement and reconstruction using the Ilizarov technique using a TSF application. The most common complication was pin-site infection. Optimising patients through cessation of smoking and encouraging post-operative weight-bearing can reduce the complication rate and improve time to union. Clinical significance The Ilizarov technique using a TSF can treat significant deformities that result from the management of tibial osteomyelitis. How to cite this article Geetala R, Zhang J, Maghsoudi D, et al. The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. Strategies Trauma Limb Reconstr 2024;19(1):32-35.
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Affiliation(s)
- Rahul Geetala
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - James Zhang
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Daniel Maghsoudi
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Amindu Madigasekara
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
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British Limb Reconstruction Society Research Collaborative, Graham SM. Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom. Strategies Trauma Limb Reconstr 2024; 19:1-8. [PMID: 38752185 PMCID: PMC11091900 DOI: 10.5005/jp-journals-10080-1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/06/2023] [Indexed: 05/18/2024] Open
Abstract
Introduction Limb reconstruction surgery (LRS) has a wide range of clinical applications within orthopaedic and trauma surgery. We sought a consensus view from limb reconstruction healthcare practitioners across the United Kingdom to help guide research priorities within LRS. Our aim is to guide future clinical research in LRS, and assist healthcare practitioners, clinical academics, and funding bodies in identifying key research priorities to improve patient care. Materials and methods A modified Delphi approach was used; it involved an initial scoping survey and a 2-round Delphi process to identify the consensus research priorities in both adult and paediatric LRS. Participants were asked to rank approved submitted questions according to perceived importance on a 5-point Likert scale, where 1 represented lowest importance and 5 indicated highest importance. Mean scores were calculated to identify a consensus of the top ten research priorities for adult and paediatric LRS. Results One hundred and fifteen participants primarily from across the United Kingdom working in LRS contributed to the modified Delphi process. Participants ranked and then re-ranked the presented research topics in terms of perceived importance. This led to the identification of a top ten research priorities in both adult and paediatric LRS, respectively, based on the collective responses of LRS practitioners. The highest-ranked questions in both adult and paediatric practice related to how to best assess and record patient-reported outcome measures (PROMs) in LRS patients. Other priorities included the effectiveness of specialist physiotherapy, the use of patient-focused psychological support, and the use of various operative management strategies for infection and limb length discrepancies. Conclusion We present a consensus-driven research priority study that outlines the key research topics and themes determined by healthcare professionals within LRS in the United Kingdom. Clinical significance These questions will assist funding bodies in prioritising where research funding may be best utilised and help drive future improvement in patient care. How to cite this article British Limb Reconstruction Society Research Collaborative. Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom. Strategies Trauma Limb Reconstr 2024;19(1):1-8.
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Affiliation(s)
| | - Simon Matthew Graham
- Simon Matthew Graham, Associate Professor of Orthopaedic Trauma, Oxford Trauma and Emergency Care, Nuffield, Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, e-mail:
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Fang S, Zhang L, Yang Y, Wang Y, Guo J, Mi L. Finite element analysis comparison of Type 42A2 fracture fixed with external titanium alloy locking plate and traditional external fixation frame. J Orthop Surg Res 2023; 18:815. [PMID: 37907959 PMCID: PMC10619248 DOI: 10.1186/s13018-023-04307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/21/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND At present, not all Type AO/OTA 42A2 open fractures can be treated by external fixation brackets, not to mention the inconvenience of this technique in clinical practice. External titanium alloy locking plates, which are lightweight and easy-to-operate, can be used as an alternative treatment option for such patients. However, there are few reports of finite element biomechanical analysis on the titanium alloy locking plates and fixation brackets being placed on the medial side of the tibial fracture. In this study, the biomechanical properties of titanium alloy locking plates and fixation brackets for treating Type AO/OTA 42A2 fractures were compared by applying the finite element method, and the results provided data support for the clinical application of the external titanium alloy locking plate technique. METHODS Type AO/OTA 42A2 fracture models were constructed using CT data of a male volunteer for two external fixation techniques, namely the external titanium alloy locking plate technique and the external fixation bracket technique, according to commonly-used clinical protocols. Then, the four-point bending, axial compression, clockwise rotation and counterclockwise rotation tests under the maximum load were simulated in finite element analysis software. The stress distribution, peak stress and overall tibial displacement data for the two different external fixation techniques were obtained and compared. RESULTS In the four different test conditions (i.e., four-point bending, axial compression, clockwise torsion, counterclockwise torsion) under the maximum load, the two external fixation techniques showed obvious von Mises stress concentration at the contacts between the screw and tibia, between the screw and titanium alloy locking plate, between the self-tapping self-drilling needle and tibia, between the self-tapping self-drilling needle and the external fixation device, as well as around the fracture end and around the cortical bone at the upper and lower ends of the tibia. The peak stress was ranged 26.67-558.77 MPa, all below the yield stress strength of titanium alloy. The peak tibial displacement of the external titanium alloy locking plate model was smaller than that of the fixation bracket model. In terms of structural stability, the external titanium alloy locking plate technique was superior to the external fixation bracket technique. CONCLUSIONS When fixing Type AO/OTA 42A2 fractures, external titanium alloy locking plates are not only lightweight and easy-to-operate, but also have better performance in terms of axial compression, bending and torsion resistance. According to the finite element biomechanical analysis, external titanium alloy locking plates are superior to traditional external fixation brackets in treating Type AO/OTA 42A2 fractures and can better meet the needs of clinical application.
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Affiliation(s)
- Shitao Fang
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Ling Zhang
- Department of Nursing, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Yunqi Yang
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Yun Wang
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Jinkun Guo
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Lei Mi
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China.
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Williams LM, Stamps G, Peak H, Singh SK, Narayan B, Graham SM, Peterson N. Circular External Fixator Removal in the Outpatient Clinic Using Regional Anaesthesia: A Pilot Study of a Novel Approach. Strategies Trauma Limb Reconstr 2023; 18:7-11. [PMID: 38033926 PMCID: PMC10682553 DOI: 10.5005/jp-journals-10080-1582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction External fixator (EF) devices are commonly used in the management of complex skeletal trauma, as well as in elective limb reconstruction surgery for the management of congenital and acquired pathology. The subsequent removal of an EF is commonly performed under general anaesthesia in an operating theatre. This practice is resource-intensive and limits the amount of time available for other surgical cases in the operating theatre. We aimed to assess the use of regional anaesthesia as an alternative method of analgesia to facilitate the EF removal in an outpatient setting. Design and methods This prospective case series evaluated the first 50 consecutive cases of EF removal in the outpatient clinic between 10/06/22 and 03/02/23. Regional anaesthesia using ultrasound-guided blockade of peripheral nerves was administered using 1% lidocaine due to its rapid onset and short half-life. Patients were assessed for additional analgesia requirements and then were asked to evaluate their experience and perceived pain using the visual analogue scale (VAS). Results Fifty patients were included in the study. The mean age was 46.8 years (range 21-85 years). About 54% of the patients were male patients (N = 27). Post-procedure, all patients indicated positive satisfaction ratings, each participant responded as either 'satisfied' (N = 6), 'very satisfied' (N = 24) or 'highly satisfied' (N = 20). In addition, 90% of the participants reported that they would opt for this method of EF removal again in future. The VAS for pain immediately following completion of the procedure was low, with a mean score of 0.36 (range 0-4), where a score of 0 = 'No pain', and 10 = 'worst pain possible'. The median score was 0. Conclusion We present the first description of outpatient EF removal using regional anaesthesia, with a prospective case series of 50 fully conscious patients from whom the EF was removed. This novel technique is likely to be cost-effective, reproducible, and safe. This technique reduces the burden of EF removal from an operating list and also improves the patient's experience when compared with other forms of conscious sedation. By eliminating the use of Entonox and methoxyflurane for sedation and analgesia, this technique also demonstrates a method of improving environmental sustainability. How to cite this article Williams LM, Stamps G, Peak H, et al. Circular External Fixator Removal in the Outpatient Clinic Using Regional Anaesthesia: A Pilot Study of A Novel Approach. Strategies Trauma Limb Reconstr 2023;18(1):7-11.
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Affiliation(s)
- Luke Michael Williams
- Department of Limb Reconstruction, Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, United Kingdom
| | - Giles Stamps
- Department of Limb Reconstruction, Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, United Kingdom
| | - Helen Peak
- Department of Limb Reconstruction, Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, United Kingdom
| | - Shiv Kumar Singh
- Department of Anaesthetics, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, England, United Kingdom
| | - Badri Narayan
- Department of Limb Reconstruction, Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, United Kingdom
| | - Simon Matthew Graham
- Department of Limb Reconstruction, Trauma & Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, United Kingdom; Department of Orthopaedics, Oxford University, Oxford, England, United Kingdom
| | - Nicholas Peterson
- Department of Limb Reconstruction, Trauma & Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, United Kingdom
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Corona PS, Carbonell-Rosell C, Vicente M, Serracanta J, Tetsworth K, Glatt V. Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect. Arch Orthop Trauma Surg 2022; 142:3877-3887. [PMID: 34936017 PMCID: PMC9596551 DOI: 10.1007/s00402-021-04299-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. MATERIALS AND METHODS A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. PRIMARY OUTCOMES limb salvage rate and infection eradication. SECONDARY OUTCOMES patient functional outcomes and satisfaction. RESULTS Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6-600) and 5.4 cm (1-23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were "very satisfied" with the treatment outcome. CONCLUSION A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.
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Affiliation(s)
- Pablo S Corona
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carla Carbonell-Rosell
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Matías Vicente
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Serracanta
- Department of Plastic Surgery and Major Burn, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Orthopaedic Research Centre of Australia, Brisbane, Australia
| | - Vaida Glatt
- Orthopaedic Research Centre of Australia, Brisbane, Australia
- Department of Orthopaedic Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Liu K, Liu Y, Cai F, Fan C, Ren P, Yusufu A. Efficacy comparison of trifocal bone transport using unilateral external fixator for femoral and tibial bone defects caused by infection. BMC Surg 2022; 22:141. [PMID: 35413897 PMCID: PMC9004006 DOI: 10.1186/s12893-022-01586-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/05/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the clinical and functional outcomes of patients with femoral and tibial critical-sized bone defect (CSBD) treated by trifocal bone transport using the Ilizarov method. METHODS From March 2011 and January 2017, clinical and radiographic data of patients with CSBD (> 6 cm) caused by infection were documented and analyzed. Patients were divided into the femur group (n = 18) and tibia groups (n = 21) according to the location of bone transport. The bone and functional outcomes were evaluated according to the Association for the Study and Application of the Method of the Ilizarov (ASAMI) criterion, and postoperative complications were evaluated by Paley classification. RESULTS A total of 39 patients were managed by the trifocal bone transport for the femur (n = 18) or tibia (n = 21) bone defects with a mean follow-up time of 26.1 months (range 17-34 months). Eighteen femurs and 21 tibias with a mean distraction regenerate length (DRL) of 8.3 cm (range 6-13 cm) and 7.5 cm (range 6-11 cm) respectively. Infection was eradicated in all patients, and the total bone union was received in all cases (100%). Statistical difference of bone grade (excellent/good/fair/poor, 3/11/3/1 vs 2/13/4/2, P < 0.05), and function grade (excellent/good/fair/poor, 3/14/1/0 vs 4/13/3/1, P < 0.05) were respectively observed between the femur group and tibia group. The excellent and good rate of bone (femur vs tibia, 77.8% vs 71.4%), and function grade (femur vs tibia, 94.4% vs 80.9%) was higher in the femur group than the tibia. The rate of complication in the femur group was lower than in the tibia (femur vs tibia, 94.4% vs 76.2%). One femur and five tibias were performed additional surgery for delayed union and axial deviation. CONCLUSIONS The trifocal bone transport using the unilateral external fixator was a practical method in the management of CSBD in the lower extremity. The BUT and EFI of the femur group were shorter than the tibia. Although the complications noted were more frequent on the femur, these were mostly minor.
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Affiliation(s)
- Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830054, Xinjiang, China
| | - Yanshi Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830054, Xinjiang, China
| | - Feiyu Cai
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830054, Xinjiang, China
| | - Chenchen Fan
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830054, Xinjiang, China
| | - Peng Ren
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830054, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830054, Xinjiang, China.
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Patel KH, Logan K, Krkovic M. Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series. World J Orthop 2021; 12:495-504. [PMID: 34354937 PMCID: PMC8316841 DOI: 10.5312/wjo.v12.i7.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/16/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies. Our aim was to provide an overview of the largest single-center experience in the literature, with minimum 1-year follow-up, of adult type 3 open tibial shaft fractures at Cambridge University Hospitals (a United Kingdom major trauma center). We sought to define patient characteristics and our main outcome measures were infection, union and re-fracture.
AIM To retrospectively define patient and injury characteristics, present our surgical methods and analyze our outcomes–namely infection, union and re-fracture rates.
METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020 (26 classified as Gustilo-Anderson 3A, 47 were 3B and two were 3C). Nine patients underwent intramedullary nailing (IMN), 61 underwent Taylor spatial frame (TSF) fixation and 5 were treated with Masquelet technique (IMN and subsequent bone grafting).
RESULTS Mean follow-up was 16 mo (IMN) and 25 mo (TSF). We had an infection rate of 6.7% (5), non-union rate of 4% (3) and re-fracture rate of 2.7% (2). Average time to union was 22 wk for IMN and 38.6 wk for TSF. Thirty-three cases had a bone defect with a mean of 5.4 cm (2-11). Patient age, sex, diabetes, smoking status or injury severity did not have a significant effect on union time with either fixation method. Our limb salvage rate was 98.7%.
CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN. Grade 3B/C injuries are best treated by circular external fixators as they provide good, reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.
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Affiliation(s)
- Kavi H Patel
- Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, United Kingdom
| | - Karl Logan
- Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, United Kingdom
| | - Matija Krkovic
- Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, United Kingdom
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Beth Z, Hahn D, Kramer B, Tirre C, Kruse D, Stone PA. Open Tibial Fracture Complicated by Wound Botulism: A Case Study. J Foot Ankle Surg 2021; 60:600-604. [PMID: 33653654 DOI: 10.1053/j.jfas.2019.04.020] [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: 10/04/2017] [Revised: 01/15/2019] [Accepted: 04/30/2019] [Indexed: 02/03/2023]
Abstract
Botulism is a neuroparalytic disease most commonly caused by foodborne ingestion of neurotoxin types A, B, and E, and is often fatal if untreated. Clinicians should be able to recognize the classic symptoms of botulinum intoxication (12). Owing to its rarity, there are a limited number of studies evaluating the clinical care of patients with wound botulism (10). We present an infected tibial non-union with botulism who underwent a successful radical excision and bone transport. The patient tolerated the procedure well.
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Affiliation(s)
- Zach Beth
- Second Year Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1719 East 19th Avenue #520, Denver, CO 80218
| | - David Hahn
- Orthopedic Surgeon Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1601 E 19th Ave #3300, Denver, CO 80218
| | - Bryan Kramer
- Vascular Surgeon Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1601 East 19th Ave Ste 3950, Denver, CO 80218
| | - Conrad Tirre
- Plastic Surgeon Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 2535 S Downing St #440, Denver, CO 80210
| | - Dustin Kruse
- Director of Research, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1719 East 19th Avenue #520, Denver, CO 80218
| | - Paul A Stone
- Residency Director, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1719 East 19th Avenue #520, Denver, CO 80218.
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Naude JJ, Manjra MA, Birkholtz F, Barnard AC, Tetsworth K, Glatt V, Hohmann E. Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures. Strategies Trauma Limb Reconstr 2021; 16:32-40. [PMID: 34326900 PMCID: PMC8311744 DOI: 10.5005/jp-journals-10080-1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective The purpose of this study was to compare clinical results following complex proximal, midshaft, and distal tibial fractures and investigate whether there are differences in outcomes between these locations. Materials and methods Patients between 18 years and 65 years of age and minimum follow-up of 12 months with complex tibial fractures treated with a circular ring fixator were included. Functional outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) functional and bone scores, Foot Function Index (FFI), Four Step Square Test (FSST), and Timed Up and Go Test (TUG). Quality of life was assessed by the EQ-5D score. Results A total of 45 patients were included: proximal fractures, n = 11; midshaft fractures, n = 17; and distal fractures, n = 17. ASAMI functional (p = 0.8) and bone scores (p = 0.3) were not different. Excellent and good bone scores were achieved in >90% in all groups. FFI was 30.9 + 24.7 in the proximal group, 33.9 + 27.7 in the midshaft group, and 28.8 + 26.9 in the distal group (p = 0.8). TUG was 9.0 + 2.7 sec in the proximal group, 9.0+3.5 in the midshaft group, and 8.5+2.0 in the distal group (p = 0.67). FSST was 10.7 + 2.5 sec in the proximal, 10.3 + 3.8 in the midshaft, and 8.9 + 1.8 in the distal fracture groups (p = 0.5). EQ-5D index value was highest in the distal (0.72), lowest in the proximal (0.55), and 0.70 in the midshaft fracture groups (p = 0.001). EQ-5D VAS was significantly different between the proximal (65) and midshaft (82.3) (p = 0.001) and between the distal (75) and proximal (65) fracture groups (p = 0.001). Conclusions The results of this study suggest that the functional outcomes between proximal, midshaft, and distal complex tibial fractures are comparable. Their ability to ambulate afterward is comparable to age-related normative data, but complex tasks are more difficult and better compared to the ambulating ability of a healthy population aged 65 to 80 years. Patients with proximal tibial fractures had significantly more disability by at least one functional level and/or one health dimension. How to cite this article Naude JJ, Manjra MA, Birkholtz F, et al. Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures. Strategies Trauma Limb Reconstr 2021;16(1):32-40.
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Affiliation(s)
- Jaco J Naude
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa
| | - Muhammad A Manjra
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa
| | - Franz Birkholtz
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa
| | | | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Department of Surgery, School of Medicine, University of Queensland, Herston, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia; Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia
| | - Vaida Glatt
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Erik Hohmann
- School of Medicine, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates
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10
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What is the optimal timing for bone grafting during staged management of infected non-unions of the tibia? A systematic review and best evidence synthesis. Injury 2020; 51:2793-2803. [PMID: 33131793 DOI: 10.1016/j.injury.2020.10.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To summarize the best available evidence with regards to timing of staged bone grafting for infected tibial non-union, and to extract evidence-based criteria indicating when bone grafting can be safely performed. METHODS Medline, Embase, Scopus, and Google Scholar were searched, and publications of evidence Level I-IV from 2000 to 2020 were included. Risk of bias was assessed with the Cochrane Collaboration's Risk of Bias Tool and ROBINS-I tool. Study quality was assessed with the GRADE system, Coleman methodology score, and Methodological Index for Non-Randomized Studies (MINORS). Heterogeneity was assessed with the I2 statistic. A forest plot was used to pool the timing of bone grafting for all included studies. For data synthesis and analysis, a best evidence synthesis was used. RESULTS A total of 15 studies were included (353 cases). Risk of bias was high in 8 studies and the quality for 14 studies was assessed as very low, with a mean Coleman score of 33.5 and a mean MINORS score of 7.9. The mean time from the index surgery to bone grafting was 7.03 weeks ranging from 2 to 15 weeks (lower limit 6 weeks, upper limit 8.07 weeks). Best evidence analysis demonstrated that 8 of the 15 studies (53%) with 237 cases (67%) performed staged bone grafting inside this window. Union was achieved in 92%. CONCLUSION The results of this best evidence systematic review suggest that, for most infected tibial non-unions, secondary bone grafting can be successfully performed between 6-8 weeks with expected union rates over 90%.
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Oka Y, Kim WC, Yoshida T, Nakase M, Kotoura Y, Nishida A, Wada H, Shirai T, Takahashi K. Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb. Strategies Trauma Limb Reconstr 2020; 15:179-183. [PMID: 34025800 PMCID: PMC8121111 DOI: 10.5005/jp-journals-10080-1454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim To describe the novel hybrid fixation technique for paediatric femoral supracondylar fracture during circular external fixation of the lower limb. Background The Ilizarov external fixator is commonly used for various orthopaedic conditions. Difficulties associated with external fixation have previously been described. A fall while using a circular external fixator can cause ipsilateral fracture. Such fractures are ideally treated conservatively, but it is difficult to fix the frame itself. No study has reported the treatment of paediatric femoral supracondylar fracture during circular external fixation. Herein, we describe a novel hybrid fixation technique that was successfully used to treat paediatric femoral supracondylar fracture in three paediatric patients with circular external fixators. Technique The fracture was manually manipulated and reduced by slight hyperextension of the lower extremity under general anaesthesia. After confirmation of good reduction, a stockinette, a cast padding, and a thin core cast were applied to the ipsilateral thigh. The hinge parts were attached to the medial and lateral sides of the proximal ring. The rods were connected to the medial and lateral hinges, and the half ring was connected to the ventral side of the proximal end. Under fluoroscopic confirmation, the thin core cast of the thigh and rods were connected by cast rolled in a figure-of-eight manner. The hinges were locked with the knee joint slightly flexed. Conclusion The minimally invasive hybrid fixation technique enables conservative treatment of paediatric femoral supracondylar fracture during circular external fixation of the lower limb with no complications, and early exercise and recovery. Clinical significance This novel hybrid fixation technique will be an effective method for paediatric femoral supracondylar fracture in patients with a circular external fixator. How to cite this article Oka Y, Kim W-C, Yoshida T, et al. Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb. Strategies Trauma Limb Reconstr 2020;15(3):179–183.
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Affiliation(s)
- Yoshinobu Oka
- Department of Pediatric Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Wook-Cheol Kim
- Department of Pediatric Orthopaedics and Ilizarov Center, Uji Takeda Hospital, Kyoto, Japan
| | - Takashi Yoshida
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Masashi Nakase
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Yoshihiro Kotoura
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Atsushi Nishida
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Hiroaki Wada
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Toshiharu Shirai
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
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12
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Hao ZC, Xia Y, Xia DM, Zhang YT, Xu SG. Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study. BMC Musculoskelet Disord 2019; 20:311. [PMID: 31266474 PMCID: PMC6607594 DOI: 10.1186/s12891-019-2679-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 06/12/2019] [Indexed: 02/03/2023] Open
Abstract
Background The treatment of open tibial shaft fractures is challenging. External fixation (EF) is comparatively safe in treating these open injuries, meanwhile it has the advantages of easy application, minimal additional disruption, and convenient subsequent soft tissue repair. Nevertheless, its application is accompanied by a series of problems in alignment and bone healing. Therefore, limited internal fixation (LIF), such as cortical screws, has been used based on the external fixator for better therapeutic effect. The aim of this study is to compare the outcomes of EF combined with LIF and simple EF in the management of open tibial shaft fractures, evaluating the efficacy and safety of using the combined technique in treating such fractures. Methods From January 2012 to December 2016, patients with open tibial shaft fractures treated with EF with or without LIF augmentation were identified. A total of 152 patients were included in the analysis, and there were 85 patients in the simple external fixation group and 67 patients in the EF-LIF group. General assessment indicators included the direct cost of hospitalization and the times of first surgery, full weight bearing, and complete union. Infections and complications in union or limb alignment were compared as primary outcomes. Additionally, the number of patients who changed the fixation system for various reasons were analysed. Results Effective follow-up of all participants for statistical analysis was obtained. The follow-up time averaged 17.15 months (range: 12.00 to 24.00 months) in the EF group and 16.20 months (range: 12.00 to 19.00 months) in the EF-LIF group. Combined fixation provided shortened time to bear full weight and achieve complete bone union, while requiring additional first surgery time. No significant difference was found in infection rates or direct cost of hospitalization. Delayed union and non-union in the EF-LIF group were significantly decreased (20.9% versus 40.0, 1.5% versus 14.1%, p < 0.05). In limb alignment, patients with combined fixation exhibited reduced malreduction, loss of reduction, and malunion. In terms of secondary fixation, the EF-LIF group showed a markedly lower incidence (5.8% versus 34.1%, p < 0.001). Conclusion Compared with simple EF, combined fixation is an effective and safe alternative for management of open tibial diaphyseal fractures. It provides superior initial reduction, better stability and decreases the risk of inferior alignment and delayed union without increasing the risk of infection.
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Affiliation(s)
- Zi-Chen Hao
- Department of Emergency, Trauma Center, Changhai Hospital, The Second Military Medical University, No 168, Changhai Road, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Yan Xia
- Department of Emergency, Trauma Center, Changhai Hospital, The Second Military Medical University, No 168, Changhai Road, Yangpu District, Shanghai, 200433, People's Republic of China
| | - De-Meng Xia
- Department of Emergency, Trauma Center, Changhai Hospital, The Second Military Medical University, No 168, Changhai Road, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Yun-Tong Zhang
- Department of Emergency, Trauma Center, Changhai Hospital, The Second Military Medical University, No 168, Changhai Road, Yangpu District, Shanghai, 200433, People's Republic of China.
| | - Shuo-Gui Xu
- Department of Emergency, Trauma Center, Changhai Hospital, The Second Military Medical University, No 168, Changhai Road, Yangpu District, Shanghai, 200433, People's Republic of China.
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The relationship between gait and functional outcomes in patients treated with circular external fixation for malunited tibial fractures. Gait Posture 2019; 68:569-574. [PMID: 30640157 DOI: 10.1016/j.gaitpost.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower extremity fractures have a profound negative effect on a patient's gait and outcomes. Correction of deformity, and with it normalization of objective gait parameters, may result in better subjective and objective functional outcomes in patients treated with circular external fixation for malunited tibial fractures. AIM The purpose of this study was to investigate the relationships between gait parameters, patient reported outcome measures (PROMs), and health related quality of life measures in patients treated with circular external fixation for the correction of deformity related to tibial malunions. METHODS This retrospective study included patients with posttraumatic tibial deformities, aged 14-65, with a minimum follow-up of 24 months following deformity correction. Patients with congenital deformities, head injuries, spinal cord injury, neurological disorders, or contralateral lower limb amputation were excluded. Functional outcomes were assessed by the Foot Function Index (FFI); Short Form 12 (SF-12); the EQ 5D; and the ASAMI score. Gait analysis was performed using Dartfish® and the Edinburgh Visual Gait Score (EVGS). The relationships between the EVGS and functional outcome scores were analyzed using Pearsons' moment correlations with Bonferroni corrections. RESULTS Eleven patients with a mean age of 42 (range 23-57) were analyzed. The mean EVGS was 2.6 ± 2.1, the mean FFI 29.6 ± 33.4, the mean EQ5 Index Value 0.7 ± 0.2, the mean EQ5 VAS 85.4 ± 19.5, the SF12 mean Physical Component Score (PCS) 46.7 ± 11.1, and the mean Mental Component Score (MCS) 55.2 ± 7.5. The following relationships were strong and significant: EVGS and FFI (r = 0.7; P = 0.02), EVGS and PCS (r = -0.82; P = 0.02), and FFI and EQ5 (r = -0.79, P = 0.05). SIGNIFICANCE The results of this study suggest that correction of deformity with realignment and restoration of normal anatomy was associated with improved functional outcomes and physical well-being. Patient reported quality of life is strongly associated with patient perceived functional outcome, but not with objective gait parameters.
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Naude J, Manjra M, Birkholtz FF, Barnard AC, Glatt V, Tetsworth K, Hohmann E. Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex. Strategies Trauma Limb Reconstr 2019; 14:142-147. [PMID: 32742430 PMCID: PMC7368362 DOI: 10.5005/jp-journals-10080-1443] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim The purpose of this study was to compare the functional and radiological outcomes of complex tibia fractures treated with two different hexapod fixators. Material and methods This is a retrospective comparative study of patients treated for complex tibial fractures between 2010 and 2015. Inclusion criteria was patients between 18 years and 60 years of age, who sustained a complex comminuted open or closed tibial fracture with or without bone loss, who had a minimum of 12 months’ follow-up, and who have been treated definitively using either Taylor Spatial Frame (TSF) or TrueLok-Hexapod System (TL-HEX). The outcome measures were Association for the Study and Application of the Method of Ilizarov (ASAMI) score, foot function index (FFI), EQ5-D, four-step square test (FSST), and timed up and go (TUG) test. Descriptive statistics were used to assess patient demographic information. Categorical variables (ASAMI and EQ5D-5L) were analysed using the χ2 test. Continuous variables (FFI, functional tests, and radiographic outcomes) were analysed with two-tailed Student’s t tests. Results In all, 24 patients were treated with the TL-HEX and 21 with the TSF. The mean time for external fixation was 219 ± 107 days (TL-HEX) and 222 ± 98 days (TSF). Union occurred in 92% (TL-HEX) and 100% (TSF). The mean follow-up was 777 ± 278 days (TL-HEX) and 1211 ± 388 days (TSF). Using the ASAMI scores, there were 17 excellent and 6 good results for the TL-HEX and 10 excellent and 11 good results for the TSF (p = 0.33). The FFI was 30 ± 28.7 (TL-HEX) and 26.1+23.9 (TSF) (p = 0.55). The EQ5D was 0.67 ± 0.3 (TL-HEX) and 0.73 ± 0.2 (TSF) (p = 0.43). The mean TUG and FSST were 9.2 ± 3.2 and 10 ± 2.9 seconds (TL-HEX) and 8.4 ± 2.3 and 9.6 ± 3.1 seconds (TSF) (p = 0.34 and 0.69). Conclusion The results of this study suggest that both hexapod external fixation devices have comparable clinical, functional, and radiographic outcomes. Either fixator can be used for the treatment of complex tibial fractures, anticipating good and excellent clinical outcomes in approximately 80% patients. Level of evidence Therapeutic level III How to cite this article Naude J, Manjra M, Birkholtz FF, et al. Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex. Strategies Trauma Limb Reconstr 2019;14(3):142–147.
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Affiliation(s)
- Jaco Naude
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Muhammad Manjra
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Franz F Birkholtz
- Department of Trauma and Orthopaedics, University of Pretoria, Pretoria, Gauteng, South Africa; Walk-a-Mile Centre for Advanced Orthopaedics, Centurion, South Africa
| | - Annette-Christy Barnard
- Department of Orthopaedic Surgery, Walk-a-Mile Centre for Advanced Orthopaedics, Pretoria, Gauteng, South Africa
| | - Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Erik Hohmann
- Medical School, University of Pretoria, Pretoria, Gauteng, South Africa
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Douras P, Tosounidis T, Giannoudis PV. Application of the 'diamond concept' with fast bone marrow aspirate concentration for the treatment of medial malleolus non-union. Injury 2018; 49:2326-2330. [PMID: 30526927 DOI: 10.1016/j.injury.2018.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Panagiotis Douras
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Theodoros Tosounidis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece.
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.
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16
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Molepo M, Barnard AC, Birkholtz F, Tetsworth K, Glatt V, Hohmann E. Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1617-1624. [PMID: 29797094 DOI: 10.1007/s00590-018-2231-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical and functional outcomes of failed plate fixation in distal tibia fractures salvaged with hexapod circular fixators. MATERIALS AND METHODS The database of a specialized limb reconstruction center was searched for all patients with failed plate fixation undergoing limb reconstruction with a circular external fixator between 2008 and 2017. Patients between the ages of 18-65 years, with a symptomatic distal tibia malunion or non-union following plate and screw fixation were included. The SF-12 and Foot Function Index (FFI) scoring systems were used to measure clinical and functional outcomes. RESULTS Ten patients with a mean age of 38 ± 13 years met the inclusion criteria. Seven patients had an infected non-union, two hypertrophic non-unions, and one a malunion. The mean follow-up was 41.7 ± 28.3 months. The mean duration of external fixation was 232.9 ± 146.6 days. The SF-12 demonstrated a mean score of 49.4 ± 7.7 for the physical component and a mean score of 55.3 ± 8.1 for the mental component. Five patients (50%) scored above 45 points for the SF12 physical component, and nine patients (90%) scored above 45 points for the mental component, indicating good outcome can be achieved. The mean FFI score was 24.9 ± 19.9, and six patients had a score below 14 points (good outcome). Radiological union was observed in all 10 patients at a mean of 29 ± 14 months. CONCLUSIONS The results of this study suggest that hexapod circular external fixation is an attractive surgical alternative for the treatment of failed plate fixation of distal tibial fractures, and can reliably achieve bony union and result in very satisfactory clinical outcomes. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Maketo Molepo
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa
| | | | - Franz Birkholtz
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa.,Walk-A-Mile Centre for Advanced Orthopaedics, Centurion, Pretoria, South Africa
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Brisbane, Australia.,Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia.,Orthopaedic Research Centre of Australia, Brisbane, Australia
| | - Vaida Glatt
- Orthopaedic Research Centre of Australia, Brisbane, Australia.,University of Texas Health Science Center, San Antonio, Tx, USA
| | - Erik Hohmann
- School of Medicine, University of Pretoria, Pretoria, South Africa. .,Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, PO Box 414296, Dubai, United Arab Emirates.
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Tetsworth K, Paley D, Sen C, Jaffe M, Maar DC, Glatt V, Hohmann E, Herzenberg JE. Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects. Injury 2017; 48:2276-2284. [PMID: 28734494 DOI: 10.1016/j.injury.2017.07.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10cm in length. METHODS In a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates. RESULTS The mean size of the bone defect was 7cm in Group A, and 5.8cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P=0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P=0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P=0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P=0.28). CONCLUSIONS While both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures. LEVEL OF EVIDENCE Level III; Retrospective comparative study.
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Affiliation(s)
- Kevin Tetsworth
- Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; University of Queensland School of Medicine, Brisbane, QLD, Australia; Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia
| | - Dror Paley
- Paley Institute, St. Mary's Hospital, West Palm Beach, FL, USA
| | - Cengiz Sen
- Department of Orthopaedic Surgery, Medical School of Istanbul, University of Istanbul, Istanbul, Turkey
| | - Matthew Jaffe
- Wellstar Health System, OrthoAtlanta private practice group, Atlanta, GA, USA
| | - Dean C Maar
- Department of Orthopaedic Trauma, St. Vincent's Hospital, Indianapolis, IN, USA
| | - Vaida Glatt
- Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia; University of Texas Health Science Center, San Antonio, Texas, USA
| | - Erik Hohmann
- University of Queensland School of Medicine, Brisbane, QLD, Australia; Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia; Musculoskeletal Research Unit, Central Queensland University, Rockhampton, QLD, Australia.
| | - John E Herzenberg
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA
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