Anderson Classification Research Articles

Open tibial shaft fractures. Treatment with intramedullary nailing after provisional stabilization with non penetrating external fixator

ObjectiveTo evaluate the incidence of union, nonunion, deep infection and factors influencing the time of bone healing in the treatment of open tibial shaft fractures Gustilo and Anderson types I and II initially treated with a non penetrating external fixator (Pinless®) followed by an unreamed intramedullary locked nail (UTN®). MethodsIt is a prospective study of 39 open tibial shaft fractures. According to the AO classification, 16 patients (41.0%) were type A, 17 (43.6%) were type B and six (15.4%) were type C. According to the Gustilo and Anderson classification, 14 patients (35.9%) were type I and 25 (64.1%) were type II. For the definitive stabilization of the fracture were used an unreamed intramedulary locked nail (UTN®). ResultsBone healing was achieved in 97.4% of the cases, with a mean time of 21.2 weeks, ranging from 12 to 104 weeks. Deep infection was seen in 2.6% patients and malunion were seen in 5.1%. Only the presence of complications were statistically significant to the time of bone healing, with a risk of faster healing in patients without complications of 4.29 times (CI 95%: 1.25–14.71) comparing to patients with complications. ConclusionThe treatment of open tibial shaft fractures with unreamed intramedullary locked nail allows high rates of bone healing, low rates of nonunion and deep infection, and only the presence of complications is statistically significant to the time of bone healing.

Is CA19-9 Response Following Chemoradiation Therapy for Borderline Resectable Pancreatic Cancer an Early Surrogate for Eventual Survival Outcomes?

Early surrogate markers of progression-free survival (PFS) and overall survival (OS) in pancreatic cancer patients who receive chemoradiation therapy (CRT) have been poorly studied. The current study was conducted to determine whether tumor marker CA19-9 following CRT is an independent prognostic biomarker in borderline resectable pancreatic cancers. Patients who had borderline resectable pancreatic cancer per the M.D. Anderson classification and received CRT before potentially undergoing surgery between August 2006 and August 2012 were identified. Patients with pre-CRT Ca19-9 levels that were unrecorded (n = 26), ≤50 (n = 38) or associated with a bilirubin >2 (n = 13) were excluded from analysis as were those with unrecorded post-CRT CA19-9 levels (n = 6). Ninety-three patients met the study's inclusion criteria. Seventy-seven (83%) underwent induction chemotherapy before consolidative CRT. Median radiation dose was 50.4 Gy (range, 30 to 70 Gy). Concurrent chemotherapy during CRT was 5-fluorouracil (1.1%), gemcitabine-based (22.6%), or capecitabine-based (66.7%). Univariate and multivariate statistical methods were used to determine significance of the post-CRT changes in CA19-9 on PFS and OS outcomes calculated from start of treatment. Median follow-up was 14.0 months (range, 1.8 to 76 months). Estimated median OS and PFS were 16.5 and 8.3 months, respectively. On univariate analysis, post-CRT normalization of CA19-9 (≤50) was a significant prognostic factor for both OS and PFS. Median OS for patients whose CA19-9 normalized was 27.4 months compared to 15.5 months for those whose CA19-9 did not normalize (p = 0.042). Corresponding median PFS durations were 11.2 and 7.0 months (p = 0.018), respectively. The most critical determinant of OS and PFS on univariate analysis was selection of patients for surgery following CRT. Median OS was 30.8 months for patients who underwent surgery compared to 14.9 months for those who did not (p < 0.001). On multivariate analysis, post-CRT CA19-9 was no longer an independent predictor of OS or PFS. The biggest determinant of this outcome was the selection of patients for surgery following CRT with a hazard ratio of 0.33 (95% CI, 0.18-0.62, p = 0.001) for OS. An association was noted between the likelihood of undergoing surgery and CA19-9 normalization (64.3% of surgical patients, 35.7% of non-surgical patients, p = 0.002). While post-treatment normalization of CA19-9 may predict PFS or OS outcomes among borderline resectable pancreatic cancer patients treated with CRT, this effect probably influences the decision to undergo surgery, which then overshadows the impact on PFS and OS.

Fratura exposta da diáfise da tíbia – tratamento com osteossíntese intramedular após estabilização provisória com fixador externo não transfixante

ObjectiveTo evaluate the incidence of union, nonunion, deep infection and factors influencing the time of bone healing in the treatment of open tibial shaft fractures Gustilo and Anderson types I and II initially treated with a non penetrating external fixator (Pinless®) followed by an unreamed intramedullary locked nail (UTN®). MethodsIt is a prospective study of 39 open tibial shaft fractures. According to the AO classification, 16 patients (41.0%) were type A, 17 (43.6%) were type B and six (15.4%) were type C. According to the Gustilo and Anderson classification, 14 patients (35.9%) were type I and 25 (64.1%) were type II. For the definitive stabilization of the fracture were used an unreamed intramedulary locked nail (UTN®). ResultsBone healing was achieved in 97.4% of the cases, with a mean time of 21.2 weeks, ranging from 12 to 104 weeks. Deep infection was seen in 2.6% patients and malunion were seen in 5.1%. Only the presence of complications were statistically significant to the time of bone healing, with a risk of faster healing in patients without complications of 4.29 times (CI 95%: 1.25-14.71) comparing to patients with complications. ConclusionThe treatment of open tibial shaft fractures with unreamed intramedullary locked nail allows high rates of bone healing, low rates of nonunion and deep infection, and only the presence of complications is statistically significant to the time of bone healing.

Validation of Testvision, an internet‐based test for the detection of visual field loss

AbstractPurpose The aim of the present study was to determine if the program Damato Testvision (DT), www.testvision.org, adequately detects visual field loss from glaucoma.Methods DT is available in three versions and was tested on 97 patients (188 eyes). The procedure was performed with a laptop connected to a computer monitor and a mouse placed on a height adjustable table. To determine sensitivity and specificity DT was compared to two gold standards: 1; Hodapp, Parrish and Anderson classification (Hodapp) of Humphrey 30:2 and 2; doctors' diagnoses.Results A total of 361 DT Standard tests were performed on 115 eyes. DT comparisons with Hodapp achieved sensitivity and specificity of 55% and 93% respectively when comparing no disease to early glaucomatous loss (AUC; 0,871). If early loss was merged with the no disease group, the sensitivity and specificity were 78% and 90% respectively (AUC; 0.931) Compared to the doctors' diagnosis DT achieved sensitivity and specificity of 52%; 96% respectively when borderline patients were classified in the glaucoma group (AUC; 0,867). If borderline patients were classified as controls: DT achieved sensitivity and specificity of 63%; 92% (AUC; 0,897).Conclusion Our study indicates that DT may be a promising tool to detect visual field defects in a pre‐selected population. The test is successful without prior training of the test person but minimal computer knowledge is advisable. The authors believe that internet based visual field examination may play a role as an easy accessible and affordable test. With further development, DT could be a tool for glaucoma screening in the home setting. Future studies need to evaluate DTs performance in the general population without prior selection.

THE EPIDEMIOLOGY OF OPEN TIBIAL SHAFT FRACTURES IN SPORTS

BackgroundTibial shaft fracture is a common sports injury in young athletic population. Open fractures can result in significant morbidity. Our aim was to study the epidemiology, severity and soft tissue...

Risk Factors for Infection and Amputation Following Open, Combat-Related Calcaneal Fractures

High-energy open calcaneal fractures are severe injuries complicated by high rates of infection, uncertain functional outcomes, and frequent need for later amputation. We conducted a retrospective review of 102 consecutive combat-related open calcaneal fractures. Patient demographics, injury mechanisms, fracture and wound characteristics, associated fractures, and methods of fracture fixation were reviewed to determine risk factors for eventual amputation or infection. Eighty-nine patients, with a mean age of twenty-six years, sustained 102 open calcaneal fractures (thirteen bilateral). After a mean follow-up of four years (range, five to ninety-two months), 42% (forty-three limbs) underwent amputation. A delayed amputation (more than twelve weeks from the time of injury) was performed in 15% (fifteen) of 102 open calcaneal fractures. In a multivariate Cox proportional-hazards survival model with time to amputation as the end point, the blast mechanism of injury, plantar wound location, larger size of open wound (in square centimeters), and escalating Gustilo and Anderson classification types (p < 0.05 for all) were predictive of eventual amputation. At the time of the final follow-up, patients who had undergone amputation had lower visual analogue scale scores for pain (2.1 compared with 4.0; p < 0.0001) and higher Tegner activity levels (5.4 compared with 3.5; p < 0.0001) than limb salvage patients. Lower-extremity amputation following open calcaneal fractures is predicted by the injury mechanism, wound location and size, and open fracture type and severity. After short-term follow-up, patients with open calcaneal fractures eventually requiring amputation exhibit improved pain and activity levels compared with patients with continued, ostensibly successful limb salvage.

Fractures of the occipital condyle clinical spectrum and course in eight patients.

Introduction:Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs.Materials and Methods:All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years).Results:Nine cases of OCF in 8 patients were identified. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classification, 5 cases of Type III and 4 cases of Type I fractures were identified. According to Tuli's classification, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classification or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological deficits the final follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only.Discussion:OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classification or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar.

High Incidence of Pseudotumours after Hip Resurfacing Even in Low Risk Patients; Results from an Intensified MRI Screening Protocol

We intensified our screening protocol for the presence of pseudotumours in a consecutive series of patients with a hip resurfacing arthroplasty (HRA), to establish whether we should be alert to the presence of 'silent' pseudotumours. Patients categorised with high risk (11 hips) and low risk (10 hips) for pseudotumour development and a control group (23 hips) were screened with metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI). The Anderson classification to grade any metal-on-metal (MoM) disease present on MARS-MRI images was used. In 15 out of 44 MRI scans pseudotumours were observed (34.1%), of which six were graded with mild (13.6%), eight with moderate (18.2%) and one with severe MoM disease (2.3%). Twelve pseudotumours were present in asymptomatic patients (27.3%). Metal ion levels were normal in 80% of the MARS-MRI screened patients. As a consequence of our intensified screening protocol, one patient was revised for pseudotumour formation and another patient was scheduled for revision. Silent pseudotumours were observed in all three groups. Before our intensified screening protocol was initiated, no pseudotumours were encountered in our cohort of 289 HRAs. We concluded that clinical outcomes and plain radiographs for screening MoM patients underestimates the presence of pseudotumours in MoM patients. The true clinical relevance of these pseudotumours is still unclear.

Estimation of land cover areas in Najaf governorate using remote sensing techniques

In order to find out the temporal classification of the Earth's appearance for the current period, the study dealt with the analytical approach for the purpose of analyzing and displaying satellite visuals through classification, analysis and automated interpretation through software for remote sensing techniques through the (ERDAS) program, as it is an integrated program that contains supervised classification and non-directed (Classification Unsupervised) and (Global Mapper) program for the purpose of cutting satellite visuals, which consist of four satellite visuals (Landsat 7) to field visits for the purpose of ensuring the accuracy of information and identifying training areas.Then, the study area was classified according to Anderson's classification

Minimally invasive plate osteosynthesis in the treatment of multifragmentary fractures of the proximal tibia

Background Proximal tibia fractures with metaphyseal comminution present a difficult treatment challenge. Minimally invasive plate fixation (osteosynthesis) (MIPO) has theoretical advantages for the treatment of these injuries. This report presents the clinical results of the MIPO system for the treatment of a series of patients with complex proximal tibia fractures. Patients and methods Between March 2003 and February 2007, 28 consecutive patients with comminuted proximal tibia metaphyseal fractures with intra-articular extension were treated with MIPO in Benha Faculty of Medicine. The mean age of the patients was 37 years (range between 21 and 60 years). There were 22 closed fractures and six grade I open fractures (Gustilo Anderson classification). Results The average follow-up was 23 months (range 12–48). In 26 (92.8%) out of 28 patients, the fracture heeled after the index procedure and had satisfactory results. One patient had a fair result because of valgus malalignment and replating was performed. One patient had a poor result because of deep infection and loosening. Postoperative fracture alignment was satisfactory in 26 out of the 28 cases and was maintained in all patients at union. There was no deep venus thrombosis or compartment syndrome. Conclusion The MIPO can be used safely to treat complex proximal tibia fractures without the need for additional medial stabilization. Surgeons attempting to use MIPO should familiarize themselves with the significant technical differences between these and traditional plating systems to ensure satisfactory results.

Size matters: How accurate is clinical estimation of traumatic wound size?

AimsThe presentation of traumatic wounds is commonplace in the accident & emergency department. Often, these wounds need referral to specialist care, e.g. trauma & orthopaedic, plastic or maxillofacial surgeons. Documentation and communication of the size of the wound can influence management, e.g. Gustilo & Anderson classification of open fractures. Several papers acknowledge the variability in measurement of chronic wounds, but there is no data regarding accuracy of traumatic wound assessment.The authors hypothesised that the estimation of wound size and subsequent communication or documentation was often inaccurate, with high inter-observer variability. A study was designed to assess this hypothesis. MethodsA total of 7 scaled images of wounds related to trauma were obtained from an Internet search engine. The questionnaire asked 3 questions regarding mechanism of injury, relevant anatomy and proposed treatment, to simulate real patient assessment. One further question addressed the estimation of wound size. 50 doctors of varying experience across several specialities were surveyed. The images were analysed after data collection had finished to provide appropriate measurements, and compared to the questionnaire results by a researcher blinded to the demographics of the individual. ResultsOur results show that there is a high inter-observer variability and inaccuracy in the estimation of wound size. This inaccuracy was directional and affected by gender. Male doctors were more likely to overestimate the size of wounds, whilst their female colleagues were more likely to underestimate size. ConclusionsThe estimation of wound size is a common requirement of clinical practice, and inaccurate interpretation of size may influence surgical management. Assessment using estimation was inaccurate, with high inter-observer variability. Assessment of traumatic wounds that require surgical management should be accurately measured, possibly using photography and ruler measurement.

Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation

This study was conducted to evaluate the outcome of treatment for open fractures of the tibial plateau using external circular fixation combined with or without limited internal fixation. Twenty-five patients (16 males and 9 females) with open fracture tibial plateau were treated with circular external fixator with minimal internal fixation. The mean age of the patients was 36years (range between 23 and 62years). According to AO classification system, there was six (24%) C1, eleven (44%) C2, and eight (32%) C3. According to Gustilo and Anderson classification, seven (28%) were grade 1; nine (36%), grade 2; six (24%), grade 3b; and three (12%), grade 3c. According to ASAMI score, Italy, the results were excellent in 8 (32%) cases, good in 12 (48%) cases, and fair in five (20%) patients. The patients' satisfaction was significantly related to the functional results (p<0.05). Complications included skin gaping in one case 10days postoperatively. Pin tract infection was seen in 20% of cases, one case showed deep infection and no cases of septic arthritis. There is no correlation between the final outcome and articular depression (p>0.05). Ilizarov external fixator provides acceptable outcomes but with a high rate of complication rate, typical of this type of fracture. It avoids extensive soft tissue dissection.

Tratamiento del cáncer de próstata con radioterapia por modulación de intensidad, primera experiencia en Chile

Intensity modulated radiotherapy (IMRT) is an important step forward in cancer treatment.To report the first experience in Chile with IMRT for prostate cancer and compare the results obtained with different doses.From January 1997 through June 2008, 156 patients with a mean age of 70 years, were treated with radiotherapy and 121 with IMRT. Patients were staged according to American Commission on Cancer Staging. Their biochemical relapse risk was classified according to the MD Anderson classification. Patients were routinely checked during and after therapy to evaluate side effects and relapse.Median follow up was 46 months (4-120). Overall five years survival was 85%. Biochemical relapse free five years survival for low, intermediate and high risk patients was 100, 82 and 70%, respectively. Biochemical relapse free survival for patients receiving radiotherapy doses over 76 Gy was 83%, compared to 30% for those receiving lower doses (p < 0.05). Urinary and gastrointestinal acute toxicity was low in 80% and 90% of patients respectively. Late toxicity developed in less than 3% of patients.IMRT for prostate cancer is readily available and safe in Chile. Biochemical disease free survival improved with higher doses with low toxicity rates.

Intensity modulated radiotherapy treatment for prostate cancer, first experience in Chile

Intensity modulated radiotherapy (IMRT) is an important step forward in cancer treatment. To report the first experience in Chile with IMRT for prostate cancer and compare the results obtained with different doses. From January 1997 through June 2008, 156 patients with a mean age of 70 years, were treated with radiotherapy and 121 with IMRT. Patients were staged according to American Commission on Cancer Staging. Their biochemical relapse risk was classified according to the MD Anderson classification. Patients were routinely checked during and after therapy to evaluate side effects and relapse. Median follow up was 46 months (4-120). Overall five years survival was 85%. Biochemical relapse free five years survival for low, intermediate and high risk patients was 100, 82 and 70%, respectively. Biochemical relapse free survival for patients receiving radiotherapy doses over 76 Gy was 83%, compared to 30% for those receiving lower doses (p < 0.05). Urinary and gastrointestinal acute toxicity was low in 80% and 90% of patients respectively. Late toxicity developed in less than 3% of patients. IMRT for prostate cancer is readily available and safe in Chile. Biochemical disease free survival improved with higher doses with low toxicity rates.

Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

In the elderly population, reported union rates with anterior odontoid screw fixation (AOSF) for odontoid fracture (OF) treatment vary between 23 and 93% when using plain radiographs. However, recent research revealed poor interobserver reliability for fusion assessment using plain radiographs compared to CT scans. Therefore, union rates in patients aged ≥60 years treated with AOSF have to be revisited using CT scans and factors for non-union to be analysed. Prospectively gathered consecutively treated patients using AOSF for odontoid fracture with age ≥60 years were reviewed. Medical charts were assessed for demographics, clinical outcomes and complications. Patients' preoperative radiographs and CT scans were analysed to characterize fracture morphology and type, fracture displacement, presence of atlanto-dental osteoarthritis as well as a detailed morphometric assessment of fracture surfaces (in mm(2)). CT scans performed after a minimum of 3 months postoperatively were analysed for fracture union. Those patients not showing CT-based evidence of completely fused odontoid fracture were invited for radiographic follow-up at a minimum of 6 months follow-up. Follow-up CT-scan were studied for odontoid union as well as the number of screws used and the square surface of screws used for AOSF and the related corticocancellous osseous healing surface of the odontoid fragment (in %) were calculated. Patients were stratified whether they achieved osseous union or fibrous non-union. Patients with a non-union were subjected to flexion-extension lateral radiographs and the non-union defined as stable if no motion was detected. The sample included 13 male (72%) and 5 female (18%) patients. The interval from injury to AOSF was 4.1 ± 5.3 days (0-16 days). Age at injury was 78.1 ± 7.6 years (60-87 years) and follow-up was 75.7 ± 50.8 months (4.2-150.2 months). 10 patients had dislocated fractures, 14 had Type II and 4 "shallow" Type III fractures according to the Anderson classification, 2 had stable C1-ring fractures, 8 had displayed atlanto-dental osteoarthritis. Fracture square surface was 127.1 ± 50.9 mm(2) (56.3-215.9 mm(2)) and osseous healing surface was 84.0 ± 6.8% (67.6-91.1%). CT-based analysis revealed osseous union in 9 (50%) and non-union in 9 patients (50%). Union rates correlated with increased fracture surface (P = 0.02). Statistical analysis revealed a trend that the usage of two screws with AOSF correlates with increased fusion rates (P = 0.06). Stability at C1-2 was achieved in 89% of patients. CT scans are accepted as the standard of reference to assess osseous union. The current study offers an objective insight into the union rates of odontoid fractures treated with AOSF using CT scans in consecutive series of 18 patients ≥60 years. Literature serves evidence that elderly patients with unstable OF benefit from early surgical stabilization. However, although using AOSF for unstable OF yields segmental stability at C1-2 in a high number of patients as echoed in the current study, our analysis stressed that using follow-up CT scans in comparison to biplanar radiographs dramatically reduces osseous union rates compared to those previously reported for AOSF.

Craniocervical junction trauma with occipital condyle fracture; case report

Authors present the case of a unilateral occipital condyle fracture diagnosed with computed tomography (CT) in a motor vehicle accident victim. Patient had unilateral occipital condyle fracture with inferomedially displaced bone fragment, a type 3 fracture according to the Anderson and Montesano classification of occipital condyle fractures, bilaterally widened occipitoatlantal joint space, and head mowed forward in relation to the cervical spine. Described pathologic changes clearly indicated craniocervical junction ligament lesions, distinctively unilateral alar ligament lesion, apical dental ligament, and tectorial membrane. Brain CT showed brain parenchymal edema and massive subarachnoidal hemorrhage with propagation of the blood in the ventricular system. Patient was admitted to the hospital unconscious, without spontaneous breathing and carotid pulse; Glasgow Coma Scale score was 3 and he did not recover during the 20-day-long treatment.

Long-term outcome of hyperthermic isolated limb perfusion (HILP) in the treatment of locoregionally metastasised malignant melanoma of the extremities

Objective: The aim is to analyse a modified standardised HILP procedure regarding the response rates, local recurrences and complication rates.Patients and methods: 152 patients (101 females, 51 males) with an average age of 62 years and locoregionally metastasised malignant melanoma underwent HILP using melphalan and dactinomycin between 1992 and 2007. Using M.D. Anderson's classification at the time of the perfusion 51 patients presented in stage IIIA, 43 patients in stage IIIAB and 58 patients in stage IV. If indicated, lymph node dissection was performed simultaneously just before perfusion of the extremity.Results: Complete remission was observed in 91 (62.7%) of 145 patients, partial remission in 26 (17.9%) patients. 28 (19.3%) patients showed no response. The overall response rate was 80.7% (117 of 145 patients). Severe complications (Wieberdink IV/V) were seen in eight cases. The average recurrence-free survival was 17 months. The median survival was 39 months; the five-year overall survival rate was 38%. The overall survival rate was significantly influenced by the stage of the disease.Conclusion: HILP is an efficient therapy for multiple or recurrent in-transit metastases of malignant melanoma of the lower extremities. The efficiency increased by improving the technique of the perfusion. Long-term survival can be observed in patients without regional lymph node metastases or distant metastases.

Relationship between central corneal thickness and visual field defect in open-angle glaucoma

To explore the relationship between central corneal thickness (CCT) and visual field defect in open-angle glaucoma (OAG). In this cross-sectional study, we tested 344 eyes in 344 eligible patients, including 233 with normal-tension glaucoma (NTG) and 111 with primary open-angle glaucoma (POAG). The association among variables, especially that between visual field defect and CCT, was probed by multivariate regression in eyes with NTG or POAG, and in all eyes. All eyes were divided into early, moderate, or severe visual field defect groups according to Anderson's classification. Statistical analysis was performed for all cases, and for the three CCT groups. Multivariate regression analysis revealed an association between CCT and visual field defect in eyes with NTG but not in eyes with POAG or in all eyes. The eyes with early visual field defect had greater CCT than did those with severe visual field defect (533.2 versus 519.0 microm). The eyes with greater CCT had better visual field indices than did those with thinner CCT (-6.91 versus -9.17 dB). Central corneal thickness is a factor associated with the status of the visual field defect: a greater CCT is associated with a better visual field index. Other factors such as the glaucoma subtype play a role in the effect of CCT on visual field defect.

Early Management of Open Tibial Fractures in Benin - City - Result of a Structured Treatment Protocol

Open fractures of the tibia shaft are caused by major musculoskeletal injury, most times high energy transfer trauma. The determinants of a successful treatment outcome are effective infection control, skin coverage and adequate stabilization. We evaluated the outcome of a structured management protocol based on the afore mentioned determinants carried out on 39 patients with 39 open tibial shaft fractures. The fractures were categorized as type I - IIIC based on Gustillo Anderson Classification. There were 2 (5.1%) type I, 17 (43.6%) type II, 9 (23.1%) IIIA, 8 (20.5%) IIIB and 3 (7.7%) of IIIC. The treatment outcome in each group was evaluated on the basis of primary wound healing and fracture union in line with the method of treatment chosen in the protocol. Overall, primary wound closure was done in 17 (43.6%) in types I, II and IIIA with a 100%, 60% and 22% primary wound healing respectively. 15.4% wounds in type II and III (4 and 2 respectively) treated by delayed (primary) suturing proceeded to heal primarily. The success or healing rate with primary wound closure for types I & II was significantly high (x2. 8.743, of 2 P. 0.013) P

Dynamic osteosynthesis by modified Kuntscher nail for the treatment of tibial diaphyseal fractures

Background:We evaluated a series of diaphyseal fractures of the tibia using low-cost, Indian-made modified Kuntscher nail (Daga nail) with the provision of distal locking screw for the management of the tibial diaphyseal fractures.Materials and Methods:One hundred and fifty one consecutive patients with diaphyseal fractures of tibia with 151 fractures who were treated by Daga nail were enrolled. One of the patients who had died because of cancer, and the two patients who were lost to follow-up at 3 months were excluded from the study.Therefore data of 148 patients with one hundred and fortyeight fractures is described. One hundred twenty closed fractures, 20 open Grade I fractures, and eight open Grade II fractures as per Gustilo and Anderson classification were included in this study. One hundred fourteen men and 34 women, with a mean age of 38.4 years, were studied. The result were analysed for Surgical time, duration of hospitalisation, union time, union rate, complication rate, functional recovery and crutch walking time. The fractures were followed at least until the time of solid union.Results:The follow-up period averaged 15 months (range, 6–26 months). Union occurred in 140 cases (94.6%). The mean time to union was 13 weeks for closed fractures,17.8 weeks for Grade I open fractures, and 21.6 weeks for Grade II open fractures. Compartment syndrome occurred in two patients. Superficial infection occurred in five cases of Grade I and II compound fractures. Three closed fractures and one case of Grade I compound fracture required bone grafting for delayed union. Two cases of Grade II compound fracture with nonunion required revision surgery and bone grafting. Twelve cases resulted in acceptable malalignment due to operative technical error. In four cases, the distal screw breakage was seen, but none of these complications interfered with fracture healing. Recovery of joint motion was essentially normal in those patients without knee or ankle injury.Conclusion:Unreamed distally locked dynamic tibial nailing (modified Kuntscher nail/Daga nail) can produce excellent clinical results for diaphyseal tibial fractures. It has the advantages of technical simplicity, minimal cost, user-friendly instrumentation, and a short learning curve.