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Chebli D, Dhaif F, Ridha A, Schade A, Khatri C. A meta-analysis of the incidence of infections following open tibia fractures and the microorganisms that cause them in high-, middle- and low-income countries. Trop Doct 2024; 54:272-281. [PMID: 38410846 DOI: 10.1177/00494755241232171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Open tibia fractures are devastating, life changing injuries, with infection associated with substantial morbidity to the patient. Reducing infection is a research priority, but before interventional studies can be designed, the incidence of infection following this injury needs to be better defined. Our aim was to estimate the global incidence of infection following an open tibia fracture. A systematic review was performed of MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), Web of Science and Global Index Medicus. We included randomised controlled trials with more than ten participants which reported infections after open diaphyseal or distal fractures (AO 42 or 43). Primary outcome was deep infection according to the Centres for Disease Control and Prevention criteria. Secondary outcome included causative micro-organisms. A meta-analysis using a random effects model to assess incidence and between-treatment effects was performed. Thirteen studies including 1463 adults from seven middle-income countries, seven high-income countries and one low-income country were included. The incidence of infection was 12.12 person-years (95% CI 7.95-18.47). A subgroup analysis compared external fixation and intramedullary nailing showed no difference between infection rates. There were limited data on organisms, but Staphylococcus aureus was the most commonly identified. There are limited to no data on antimicrobial resistance.
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Affiliation(s)
- Djenna Chebli
- Medical Student, Warwick Medical School, University of Warwick, Coventry, UK
| | - Fatema Dhaif
- Specialist Registrar, Warwick Orthopaedic Speciality Training Rotation, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Academic Foundation Doctor, Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Ali Ridha
- Specialist Registrar, Warwick Orthopaedic Speciality Training Rotation, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Academic Foundation Doctor, Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Alexander Schade
- Wellcome Trust PhD Fellow, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
| | - Chetan Khatri
- Specialist Registrar, Warwick Orthopaedic Speciality Training Rotation, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Academic Foundation Doctor, Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
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Serapiglia VE, Patel KA, Varre JSV, Dusseau BT, DeVoe WB. Attempted repair of chest wall injury following penetrating injury with surgical stabilization rib and autologous bone graft: A case report. Trauma Case Rep 2024; 50:100984. [PMID: 38496000 PMCID: PMC10940907 DOI: 10.1016/j.tcr.2024.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 03/19/2024] Open
Abstract
Rib fractures are one of the most common injuries following blunt trauma. When associated with penetrating trauma, the projectile velocity and immense energy transfer cause significant rib fracture displacement and fragmentation. As a result, these patients are potentially exposed to an even higher risk of complications compared to those seen in more simple rib fractures. Unfortunately, there is limited research regarding technical considerations for surgical stabilization of rib fractures (SSRF) in severely displaced rib fractures with bone loss following penetrating injury. We present the case of a 21-year-old male gunshot wound victim with severely displaced and comminuted rib fractures in which we utilized an autologous bone graft bridge during SSRF to enhance fracture unionization, chest wall stability, and cosmesis. Unfortunately, the bone graft failed to incorporate into surrounding tissue.
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Affiliation(s)
- Vincent E. Serapiglia
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Krishna A. Patel
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Jaya Sai V. Varre
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Brian T. Dusseau
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - William B. DeVoe
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
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Rathod TN, Kolur SS, Rai AK, Paul D. Tibial lengthening for massive distal femoral bone loss. BMJ Case Rep 2023; 16:e254863. [PMID: 37963663 PMCID: PMC10649375 DOI: 10.1136/bcr-2023-254863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
A man in his 30s was involved in a road traffic accident (RTA) and sustained a grade-IIIA distal femur fracture with acute loss of distal two-third of the femur. Initially, damage control surgery was done by an external fixator application. Later, staged limb reconstruction surgery was undertaken as a definitive procedure that involved bifocal distraction osteogenesis involving the proximal tibia and femur along with docking of the corticotomised femoral fragment onto the tibial plateau to achieve knee arthrodesis. The tibial and femoral regenerate together measured 25.8 cm at the end of distraction phase leaving behind a limb length discrepancy of 5 cm. Acute traumatic large bone loss is a rare presentation and is beset with unique management challenges. Limb reconstruction surgery (LRS) with LRS system provides flexibility to tackle individual case-based scenarios and helps achieve limb length, maintain alignment and restore function.
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Affiliation(s)
| | | | - Abhishek Kumar Rai
- Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Dhruv Paul
- Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Plotnikovs K, Kamenska J, Movcans J, Pasters V, Solomin L, Plaudis H. Artificial Deformity Creation as a Method for Limb Salvage for Patients with Massive Tibial and Soft Tissue Defects: A Report of 26 Cases. Strategies Trauma Limb Reconstr 2023; 18:133-139. [PMID: 38404570 PMCID: PMC10891353 DOI: 10.5005/jp-journals-10080-1599] [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: 03/29/2023] [Accepted: 12/07/2023] [Indexed: 02/27/2024] Open
Abstract
Soft tissue and bone defects that occur consequence of high-energy trauma are serious and challenging problems. The aim of this retrospective cohort study is to show that the artificial deformity creation (ADCr) method allows the closure of soft-tissue defects, avoids amputation, and can facilitate the reconstruction of bone defects and restore limb length. Patients and methods Twenty-six adult patients (age range 20-81 years) with soft tissue defects of the lower limb were treated at the Riga East University Hospital from 2018 to 2021. All patients were treated using the ADCr method which is the technique of establishing an interim deformity for resolving tissue loss. The lower extremity functional scale (LEFS) and application of methods of ilizarov (ASAMI) criteria were used for the evaluation of bone healing and lower extremity function. Results Complete union was achieved in all cases. The functional evaluation showed that most patients could achieve excellent and good results and return to activities of daily living. The functional result was poor in one case of a multi-fragmentary distal tibial articular fracture for which an ankle fusion was performed. Final union in this case was achieved with some residual deformity. Conclusion The method of ADCr is an effective surgical technique in cases of severe tibial injuries with concomitant loss of bone and soft tissues. This method could be used in cases when either a plastic or microsurgeon is not available or for instances when closing the defect with a flap is either impossible or contraindicated. Excellent and good functional results are possible without severe complications. How to cite this article Plotnikovs K, Kamenska J, Movcans J, et al. Artificial Deformity Creation as a Method for Limb Salvage for Patients with Massive Tibial and Soft Tissue Defects: A Report of 26 Cases. Strategies Trauma Limb Reconstr 2023;18(3):133-139.
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Affiliation(s)
- Konstantins Plotnikovs
- Department of Traumatology and Orthopaedics, Riga East Clinical University Hospital, Riga, Latvia
| | - Jekaterina Kamenska
- Department of Traumatology and Orthopaedics, Riga East Clinical University Hospital, Riga, Latvia
| | - Jevgenijs Movcans
- Department of Traumatology and Orthopaedics, Riga East Clinical University Hospital, Latvia
| | - Vitalijs Pasters
- Department of Traumatology and Orthopaedics, Riga East Clinical University Hospital, Latvia
| | - Leonid Solomin
- Department of Orthopedics, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| | - Haralds Plaudis
- Department of General Surgery, Riga Stradins University, Riga, Latvia
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Nashi N, Kagda FHY. Current concepts of bone grafting in trauma surgery. J Clin Orthop Trauma 2023; 43:102231. [PMID: 37636005 PMCID: PMC10448478 DOI: 10.1016/j.jcot.2023.102231] [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: 05/06/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
Bone graft in trauma surgery is commonly used in managing bone defects, non-union, fracture related infections, arthrodesis or to provide structural support in fractures. A variety of bone grafts are made available to the treating physician, which includes autograft, allograft and bone graft substitutes. The future of bone grafting in trauma surgery is exciting with the incorporation of technological advancement such as gene therapy, 3D-printing and tissue engineering. Regardless, there are still limitations to what we understand regarding current bone grafting techniques with conflicting literature on their clinical utility and indication. The aim of this review article therefore is to take a step back and critically evaluate the current concepts of bone grafting in trauma surgery, with special emphasis made on reviewing the types of bone graft, biology of bone graft incorporation and indication for its use in various clinical scenarios.
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Affiliation(s)
- Nazrul Nashi
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore, 1E Kent Ridge Road, 119228, Singapore
| | - Fareed HY. Kagda
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, 1 Jurong East Street 21, 609606, Singapore
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Miloš M, Vujnović N, Bekić M, Lojpur J, Moretti M, Kirin I, Roth A. Retrograde calcaneo-talo-tibial nail, subtalar arthrodesis and fibula transposition in the treatment of traumatic bone and articulatory defect of the distal tibia and talocrural joint: A case report. Trauma Case Rep 2022; 42:100734. [DOI: 10.1016/j.tcr.2022.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
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Farhan-Alanie MM, Ward J, Kelly MB, Al-Hourani K. Current Perspectives on the Management of Bone Fragments in Open Tibial Fractures: New Developments and Future Directions. Orthop Res Rev 2022; 14:275-286. [PMID: 35983563 PMCID: PMC9380731 DOI: 10.2147/orr.s340534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
Open tibial fractures may be associated with bone loss at the time of the injury or following surgical debridement of the fracture. This article discusses the various treatment options available and the latest developments surrounding the management of free bone fragments in open tibial fractures.
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Affiliation(s)
- Muhamed M Farhan-Alanie
- Department of Trauma & Orthopaedics, University Hospital Coventry & Warwickshire, Coventry, UK
- Correspondence: Muhamed M Farhan-Alanie, Email
| | - Jayne Ward
- Department of Trauma & Orthopaedics, University Hospital Coventry & Warwickshire, Coventry, UK
| | - Michael B Kelly
- Department of Trauma & Orthopaedics, Southmead Hospital, Bristol, UK
| | - Khalid Al-Hourani
- Department of Trauma & Orthopaedics, Royal Infirmary of Edinburgh, UK
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Shish kebab technique used to treat severe trauma to the foot: a case report. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dradjat RS, Sananta P, Rosandi RD, Siahaan LD. Osteocalcin biomarker level evaluation on fracture healing with bone defect after stromal vascular fraction application in murine model. Ann Med Surg (Lond) 2021; 71:103020. [PMID: 34840768 PMCID: PMC8606847 DOI: 10.1016/j.amsu.2021.103020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Bone defect (3 mm in murine model) is a condition when the bone tissue cannot undergo a natural healing process caused by severe trauma, tumor, or irradiation. A bone defect is a challenge even for experienced Orthopaedic surgeons. Stromal vascular fraction (SVF) is a heterogeneous cell population derived from adipose tissue that results from minimal manipulation of the adipose tissue itself. Several studies have elucidated the effect of either SVF on bone defect healing. However, to the author's knowledge, there is no study evaluating the effect of SVF application on fracture healing, which was measured with osteocalcin biomarker. This study aims to evaluate the effect of SVF application on bone defect healing measured with osteocalcin as a biomarker of bone healing. Materials and methods This was an animal study involving twelve Wistar strain Rattus norvegivus. They were divided into three groups: negative group (normal rats), positive group (rats with bone defect and treated without SVF application), and SVF group (rats with bone defect and treated with SVF application). After 30 days, the rats were sacrificed, the osteocalcin biomarkers were evaluated. This biomarker was quantified using ELISA. Results Osteocalcin biomarker expressions were higher in the group treated with SVF application than those without using SVF. All comparisons of the SVF group and positive control group showed significant differences (p < 0.05). Conclusion SVF application could aid the healing process in a murine model with bone defect, marked by increased osteocalcin levels. A study evaluating the effect of SVF application on fracture healing, measured with osteocalcin biomarker. Osteocalcin is useful in the evaluation of bone turnover and the clinical setting of bone loss. SVF could aid the healing process in a murine model with bone defect. A bone defect is a challenge even for experienced Orthopaedic surgeons.
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Affiliation(s)
- Respati S Dradjat
- Teaching Staff of Orthopaedic and Traumatology Department, Faculty of Medicine Universitas Brawijaya, RSUD Dr. Saiful Anwar, Malang, Indonesia
| | - Panji Sananta
- Teaching Staff of Orthopaedic and Traumatology Department, Faculty of Medicine Universitas Brawijaya, RSUD Dr. Saiful Anwar, Malang, Indonesia
| | - Rizqi Daniar Rosandi
- Resident of Orthopaedic and Traumatology Department, Faculty of Medicine Universitas Brawijaya, RSUD Dr. Saiful Anwar, Malang, Indonesia
| | - Lasa Dhakka Siahaan
- Research Assistant Orthopaedic and Traumatology Department, Faculty of Medicine Universitas Brawijaya, RSUD Dr. Saiful Anwar, Malang, Indonesia
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Dradjat RS, Sananta P, Rosandi RD, Siahaan LD. Effect of Stromal Vascular Fraction on Fracture Healing with Bone Defects by Examination of Bone Morphogenetic Protein-2 Biomarkers in Murine Model. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Fractures and segmental bone defects are a significant cause of morbidity and a source of a high economic burden in healthcare. A severe bone defect (3 mm in murine model) is a devastating condition, which the bone cannot heal naturally despite surgical stabilization and usually requires further surgical intervention. The stromal vascular fraction (SVF) contains a heterogeneous collection of cells and several components, primarily: MSCs, HSCs, Treg cells, pericytic cells, AST cells, extracellular matrix, and complex microvascular beds (fibroblasts, white blood cells, dendritic cells, and intra-adventitial smooth muscular-like cells). Bone morphogenetic protein (BMP) is widely known for their important role in bone formation during mammalian development and confers a multifunctional role in the body, which has potential for therapeutic use. Studies have shown that BMPs play a role in the healing of large size bone defects.
AIM: In this study, researchers aim to determine the effect of administering SVF from adipose tissue on the healing process of bone defects assessed based on the level biomarker of BMP-2.
MATERIALS AND METHODS: This was an animal study involving 12 Wistar strain Rattus norvegivus. They were divided into three groups: Negative group (normal rats), positive group (rats with bone defect without SVF application), and SVF group (rats with bone defect with SVF application). After 30 days, the rats were sacrificed; the biomarkers that were evaluated are BMP-2. This biomarker was quantified using ELISA.
RESULTS: BMP-2 biomarker expressions were higher in the SVF application group than in the group without SVF. All comparisons of the SVF group and positive control group showed significant differences (p = 0.026).
CONCLUSION: SVF application could aid the healing process in a murine model with bone defect marked by the increased level of BMP-2 as a bone formation marker.
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