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Walters CL, Simister SK, Tse S, Saade A, Megerian MF, Fitzpatrick EP, Soles GL, Lee MA, Saiz AM, Campbell ST. Temporary Stabilization of Tibia Fractures: Does External Fixation or Temporary Plate Fixation Result in Better Outcomes? THE IOWA ORTHOPAEDIC JOURNAL 2024; 44:179-184. [PMID: 38919353 PMCID: PMC11195873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background Provisional stabilization of high-energy tibia fractures using temporary plate fixation (TPF) or external fixation (ex-fix) prior to definitive medullary nailing (MN) is a strategy common in damage control orthopaedics. There is a lack of comprehensive data evaluating outcomes between these methods. This study compares outcomes of patients stabilized with either TPF or ex-fix, and with early definitive MN only, assessing complications including nonunion and deep infection. Methods A retrospective review was performed on adult patients with tibia fractures treated with MN followed until fracture union (≥3 months) at a single level-1 trauma center from 2014 to 2022. Medical records were evaluated for nonunion and deep infection. Demographics, injury characteristics, and fixation methods were recorded. Significance between patients who underwent TPF and ex-fix was compared with a matched cohort of early MN using Pearson's exact tests, independent t-tests, and one-way ANOVA, depending on the appropriate variable. Results 81 patients were included; 27 were temporized with TPF (n = 12) or ex-fix (n = 15). 54 early MN cases defined the matched cohort. All groups had similar patient and fracture characteristics. The difference in rates of nonunion between groups was significant, with TPF, ex-fix, and early MN groups at 17, 40, and 11% respectively (p = 0.027). Early MN had lower rates of nonunion (11% vs. 40%, p = 0.017) and deep infection (13% vs. 40%, p = 0.028) compared to ex-fix. Conclusion Temporary ex-fix followed by staged MN was associated with higher rates of nonunion and deep infection. There was no difference in complication rates between TPF and early definitive MN. These data suggest that ex-fix followed by MN of tibia fractures should be avoided in favor of early definitive MN when possible. If temporization is needed, TPF may be a better option than ex-fix. Level of Evidence: IV.
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Affiliation(s)
| | - Samuel K. Simister
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Shannon Tse
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Aziz Saade
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Mark F. Megerian
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ellen P. Fitzpatrick
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Gillian L. Soles
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Mark A. Lee
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Augustine M. Saiz
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Sean T. Campbell
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
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Manon J, Saint-Guillain M, Pletser V, Buckland DM, Vico L, Dobney W, Baatout S, Wain C, Jacobs J, Comein A, Drouet S, Meert J, Casla IS, Chamart C, Vanderdonckt J, Cartiaux O, Cornu O. Adequacy of in-mission training to treat tibial shaft fractures in mars analogue testing. Sci Rep 2023; 13:18072. [PMID: 37872309 PMCID: PMC10593937 DOI: 10.1038/s41598-023-43878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/29/2023] [Indexed: 10/25/2023] Open
Abstract
Long bone fractures are a concern in long-duration exploration missions (LDEM) where crew autonomy will exceed the current Low Earth Orbit paradigm. Current crew selection assumptions require extensive complete training and competency testing prior to flight for off-nominal situations. Analogue astronauts (n = 6) can be quickly trained to address a single fracture pattern and then competently perform the repair procedure. An easy-to-use external fixation (EZExFix) was employed to repair artificial tibial shaft fractures during an inhabited mission at the Mars Desert Research Station (Utah, USA). Bone repair safety zones were respected (23/24), participants achieved 79.2% repair success, and median completion time was 50.04 min. Just-in-time training in-mission was sufficient to become autonomous without pre-mission medical/surgical/mechanical education, regardless of learning conditions (p > 0.05). Similar techniques could be used in LDEM to increase astronauts' autonomy in traumatic injury treatment and lower skill competency requirements used in crew selection.
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Affiliation(s)
- Julie Manon
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium.
- UCLouvain - IREC, Morphology Lab (MORF), Avenue Emmanuel Mounier 52 - B1.52.04, 1200, Brussels, Belgium.
- UCLouvain - IREC, Neuromusculoskeletal Lab (NMSK), Brussels, Belgium.
- Orthopaedic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Crew 227 - Mission Analogue Research Simulation (M.A.R.S. UCLouvain) - Mars Desert Research Station (MDRS), Utah, USA.
| | | | | | - Daniel Miller Buckland
- Human System Risk Board (HSRB), NASA Johnson Space Center, Houston, TX, USA
- Department of Emergency Medicine, Duke University, North Carolina, USA
| | - Laurence Vico
- INSERM, Mines Saint-Étienne, Univ Jean Monnet, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - William Dobney
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
- School of Aeronautical, Automotive, Chemical and Materials Engineering, Loughborough University, Loughborough, UK
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Cyril Wain
- Crew 227 - Mission Analogue Research Simulation (M.A.R.S. UCLouvain) - Mars Desert Research Station (MDRS), Utah, USA
| | - Jean Jacobs
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium
- Crew 227 - Mission Analogue Research Simulation (M.A.R.S. UCLouvain) - Mars Desert Research Station (MDRS), Utah, USA
| | - Audrey Comein
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium
- Crew 227 - Mission Analogue Research Simulation (M.A.R.S. UCLouvain) - Mars Desert Research Station (MDRS), Utah, USA
| | - Sirga Drouet
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium
- Crew 227 - Mission Analogue Research Simulation (M.A.R.S. UCLouvain) - Mars Desert Research Station (MDRS), Utah, USA
| | - Julien Meert
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium
- Crew 227 - Mission Analogue Research Simulation (M.A.R.S. UCLouvain) - Mars Desert Research Station (MDRS), Utah, USA
| | - Ignacio Sanchez Casla
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium
- Crew 227 - Mission Analogue Research Simulation (M.A.R.S. UCLouvain) - Mars Desert Research Station (MDRS), Utah, USA
| | - Cheyenne Chamart
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium
- Crew 227 - Mission Analogue Research Simulation (M.A.R.S. UCLouvain) - Mars Desert Research Station (MDRS), Utah, USA
| | - Jean Vanderdonckt
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium
| | - Olivier Cartiaux
- Department of Health Engineering, ECAM Brussels Engineering School, Haute Ecole "ICHEC-ECAM-ISFSC", Brussels, Belgium
| | - Olivier Cornu
- Université Catholique de Louvain (UCLouvain), Louvain-La-Neuve, Belgium
- UCLouvain - IREC, Neuromusculoskeletal Lab (NMSK), Brussels, Belgium
- Orthopaedic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Park KH, Park HW, Oh CW, Lee JH, Kim JW, Oh JK, Park IH, Ha SS. Conventional bicortical pin substitution with a novel unicortical pin in external fixation: A biomechanical study. Injury 2021; 52:1673-1678. [PMID: 33906742 DOI: 10.1016/j.injury.2021.04.036] [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: 10/17/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As most patients with polytrauma or open fractures are converted from temporary external fixation to definite stabilization, the prevention of complications such as infection is especially important. To overcome the high risk of infection associated with the use of the conventional bicortical pin for temporary external fixation, the authors developed a novel unicortical pin and analyzed it in a biomechanical study. METHODS The unicortical pin consisted of an inner screw, purchasing the cortical bone, and an outer sleeve with 6 spikes. A bicortical pin was used for the purpose of comparison. A fracture gap model was stabilized using a monoplanar configuration. Both the unicortical pins (Uni group) and bicortical pins (Bi group) underwent axial compressive and torsional load testing using a servo-hydraulic testing machine. Stiffness, load to failure, and mode of failure were documented. RESULTS Stiffness and load to failure of the Uni group (average, 40.5 N/mm and 1098.4 N, respectively) were greater than that of the Bi group (average, 33.7 N/mm and 968.6 N, respectively) in the axial compressive load test (P = 0.008 and 0.032). Stiffness and load to failure of the Uni group (average, 1.2 Nm/degree and 1.7 Nm, respectively) were also significantly higher than those of the Bi group (average, 0.8 Nm/degree and 0.6 Nm, respectively) in the torsional load test (P = 0.008 and 0.016). All pins in the Bi group were bent at the pin-synthetic bone interface without synthetic bone failure. Contrarily, the Uni group did not show any pin bending or failure. However, in the axial compression test, partial cracks in the synthetic bone were found at the interface with spikes in the outer shell. In addition, in the torsion test, incomplete fractures were seen through the inner screws' holes. CONCLUSION Compared with the conventional bicortical pin, the newly designed unicortical pin significantly increased fracture stability under both axial compressive and torsional loads. The unicortical pin can be considered an alternative biomechanical solution to obtain adequate stability when performing external fixation of fractures.
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Affiliation(s)
- Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
| | - Ho-Won Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea.
| | - Jin-Han Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
| | - Joon-Woo Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, School of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Il-Hyung Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
| | - Sung-Soo Ha
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
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