1
|
Zhou M, Ma Y, Jia X, Wu Y, Liu J, Wang Y, Wang P, Luo J, Lin F, Wang J, Rui Y. Comparison of free vascularized fibular grafts and the Masquelet technique for the treatment of segmental bone defects with open forearm fractures: a retrospective cohort study. J Orthop Traumatol 2024; 25:44. [PMID: 39342062 PMCID: PMC11438757 DOI: 10.1186/s10195-024-00787-x] [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: 11/29/2023] [Accepted: 09/03/2024] [Indexed: 10/01/2024] Open
Abstract
PURPOSE Severe open forearm fractures commonly involve segmental bone defects. Although several methods have been proposed to treat segmental bone defects with such fractures, research comparing the radiological and clinical outcomes of free vascularized fibular grafts (FVFG) and the Masquelet technique (MT) is rare. METHODS Data on 43 patients with open forearm fractures and segmental bone defects treated surgically in our hospital from January 2005 to January 2021 were retrospectively analyzed, and these patients were divided into an FVFG group (18 cases) and an MT group (25 cases). Clinical and radiological evaluations were performed regularly, and the minimum follow-up was 18 months. RESULTS All 43 patients were followed up for 18 to 190 months, with a mean of 46.93 months. The mean follow-up time was significantly longer in the FVFG group than in the MT group (p = 0.000). Bone healing time was 3-16 months, with a mean of 4.67 months. The QuickDASH score at the last follow-up was 0-38.6, with a mean of 17.71, and there was no statistically significant difference between the two groups. Operative time, hospital stay, and intraoperative bleeding for bone defect reconstruction were higher in the FVFG group compared to the MT group (p = 0.000), whereas the number of procedures was lower in the FVFG group than in the MT group (p = 0.035). CONCLUSIONS FVFG and the MT showed satisfactory clinical results for segmental bone defects of the forearm. Compared with FVFG, the MT exhibited a lower operative time, hospital stay, and intraoperative bleeding. LEVEL OF EVIDENCE Level IV. Trial registration This study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR2300067675; registered 17 January 2023), https://www.chictr.org.cn/showproj.html?proj=189458 .
Collapse
Affiliation(s)
- Ming Zhou
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Yunhong Ma
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Xueyuan Jia
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Yongwei Wu
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Jun Liu
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Yapeng Wang
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Peng Wang
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Junhao Luo
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Fang Lin
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Jianbing Wang
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China.
| | - Yongjun Rui
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China.
| |
Collapse
|
2
|
Schaffler BC, Konda SR. Tibial bone loss. OTA Int 2024; 7:e315. [PMID: 38840708 PMCID: PMC11149745 DOI: 10.1097/oi9.0000000000000315] [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: 11/19/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 06/07/2024]
Abstract
Critical bone loss after open fractures, while relatively uncommon, occurs most frequently in high-energy injuries. Fractures of the tibia account for the majority of open fractures with significant bone loss. A number of different surgical strategies exist for treatment of tibial bone loss, all with different advantages and disadvantages. Care should be taken by the surgeon to review appropriate indications and all relevant evidence before selecting a strategy.
Collapse
Affiliation(s)
| | - Sanjit R. Konda
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
- Jamaica Hospital Medical Center, Queens, NY
| |
Collapse
|
3
|
He J, Xia X, Zuo B, Tang J, Wang P. A review of 10 patients treated with the masquelet technique and microsurgical technique combined for Gustilo type III open tibial fractures. BMC Musculoskelet Disord 2024; 25:362. [PMID: 38714945 PMCID: PMC11075234 DOI: 10.1186/s12891-024-07478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Open tibial fractures often include severe bone loss and soft tissue defects and requires complex reconstructive operations. However, the optimal treatment is unclear. METHODS This retrospective study enrolled patients with Gustilo type III open tibial fractures from January 2018 to January 2021 to assess the clinical utility of Masquelet technique together with microsurgical technique as a combined strategy for the treatment of open tibial fractures. The demographics and clinical outcomes including bone union time, infection, nonunion and other complications were recorded for analysis. The bone recovery quality was evaluated by the AOFAS Ankle-Hindfoot Scale score and the Paley criteria. RESULTS We enrolled 10 patients, the mean age of the patients and length of bone defects were 31.7 years (range, 23-45 years) and 7.5 cm (range, 4.5-10 cm) respectively. Bone union was achieved for all patients, with an average healing time of 12.2 months (range, 11-16 months). Seven patients exhibited a bone healing time of less than 12 months, whereas 3 patients exhibited a bone healing time exceeding 12 months. No significant correlation was found between the length of bone loss and healing time. In addition, no deep infection or nonunion was observed, although 2 patients experienced wound fat liquefaction with exudates and 1 patient presented with a bloated skin flap. The average AOFAS Ankle-Hindfoot Scale score was 80.5 (range, 74-85), and all patients were evaluated as good or exellent based on the Paley criteria. CONCLUSIONS Our study indicated that the use of the Masquelet technique and the microsurgical technique as a combined strategy is safe and effective for the treatment of Gustilo type III open tibial fractures.
Collapse
Affiliation(s)
- Jingxuan He
- Department of Orthopedics, General Hospital of the Yangtze River Shipping, Wuhan city, Hubei province, 430010, China
| | - Xiaofeng Xia
- Department of Orthopedics, General Hospital of the Yangtze River Shipping, Wuhan city, Hubei province, 430010, China
| | - Bing Zuo
- Department of Orthopedics, General Hospital of the Yangtze River Shipping, Wuhan city, Hubei province, 430010, China
| | - Jiaguo Tang
- Department of Orthopedics, General Hospital of the Yangtze River Shipping, Wuhan city, Hubei province, 430010, China
| | - Peng Wang
- Department of Orthopedics, General Hospital of the Yangtze River Shipping, Wuhan city, Hubei province, 430010, China.
| |
Collapse
|
4
|
Craxford S, Vris A, Ahluwalia R, Saini A, Harrison WD, Graham S, Sharma H. Fracture related infection in open tibial fractures. J Orthop 2024; 51:98-102. [PMID: 38357441 PMCID: PMC10862397 DOI: 10.1016/j.jor.2024.01.010] [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: 08/13/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/16/2024] Open
Abstract
Open tibia fractures frequently occur following high-energy trauma. Contamination of the fracture site combined with limited soft tissue coverage and blood supply means that these open fractures are associated with a high rate of complications, including fracture related infection (FRI). FRI is associated with lowered patient outcomes and requires early recognition and appropriate surgical and medical management. The current evidence on FRI after open tibial fractures largely is limited to case series, small retrospective cohort studies and expert opinion. Recent expert consensus has produced guidelines with the aim of standardising care for these patients. This review summarises the current management strategies employed in treating FRI following open tibial fractures and where possible the evidence behind them.
Collapse
|