Open Fractures Research Articles

Paediatric open fractures presenting to a level 1 trauma centre: a 10 year epidemiological study.

The epidemiology of paediatric fractures has been previously described, however there is limited data available on open fractures in this population. The purpose of this study was to investigate trends, mechanism of injury (MOI) and severity of paediatric open fractures and undertake an epidemiological study. All children ≤ 16.0 years presenting with open fractures were identified between 01/04/2013 and 01/04/2023. Those with craniofacial, thoracic and distal phalangeal fractures were excluded. Incidence was calculated based on those presenting within the local geographical region. Social deprivation was measured using the Index of Multiple Deprivation (IMD). There were 208 open fractures with a median age of 11.0(q1 7.4-q3 13.4) years, and 153(74.6%) were in males. The MOIs were road traffic collisions 73(35.1%), sports/play 45(21.6%), fall > 2m 29(13.9%), simple fall 25(12.0%), crush 16(7.7%), bites 8(3.8%), assault 6(2.9%), and other 6(2.9%). Nineteen children (9.1%) presented with polytrauma. Gustilo-Anderson grade for long bone fractures were I-61(29.3%), II-24(11.5%), IIIa-36(17.3%), IIIb-30(14.4%) and IIIc-7(3.4%). There were 129 children presenting within the local geographical region providing an annual incidence of 8.0/100,000. Radius and ulna were the most frequently injured 49(38.0%) followed by tibia and fibula 44(34.1%). There were 69(53.5%) children presenting from an IMD quintile 1 with open fractures. Paediatric open fractures are commonly seen in the adolescent male and affect those who are from a more socially deprived background. These injuries account for 3.2% of fractures admitted to a MTC. Data suggests children principally sustain open fractures through two distinct injury patterns and ten-year trends suggests that there is a gradual decline in the annual incidence.

Risk factors for delayed return to work following tibial shaft fracture surgery.

To determine when patients return to work following operative repair of tibial shaft fractures (TSF) and what risk factors are associated with a delayed return to work (RTW), defined as greater than 180days after operative repair. Retrospective chart review was performed on a consecutive series of TSF patients who underwent operative repair. Time to RTW was based on documented work-clearance communications from the operating surgeon. Patients were divided into 3 groups based on when they returned to work: early (≤ 90days), average (91-80days), and late (≥ 180days). Univariate analysis was performed, and significant variables were included in multinomial logistic regression. There were 168 patients identified. Eighteen were excluded (retired, unemployed, or never returned to work) leaving 150 patients. The average time to RTW for the overall study population was 4.17 ± 2.06months. There were 39 (26.0%) patients in the early RTW group, 85 (56.7%) in the average RTW group, and 26 (17.3%) in the late RTW group. Patient with high-energy injuries (p = 0.024), open fractures (p = 0.001), initial external-fixation (p = 0.036), labor-intensive job (p = 0.018) and post-operative non-weight bearing status (p = 0.023) all had significantly longer RTW. Multinomial logistic regression including these parameters found a closed fracture was associated with a 1.9 decreased risk of delayed RTW (p = 0.004, 95% CI 0.039-0.533). Open fractures, initial external-fixation, restricted post-operative weight-bearing and labor-intensive jobs are associated with a delayed RTW following operative repair of TSFs. Therapeutic Level III.

HINDFOOT ANKLE RECONSTRUCTION NAIL TRIAL (HARNT): POPULATION ANALYSIS OF SURGICAL TREATMENT OF COMPLEX ANKLE FRACTURES IN THE UNITED KINGDOM

IntroductionThe management of open or unstable ankle and distal tibial fractures pose many challenges. In certain situations, hindfoot nailing (HFN) is indicated, however this depends on surgeon preference and regional variations exist. This study sought to establish the current management and outcomes of complex ankle fractures in the UK.MethodsA National collaborative study in affiliation with BOTA was conducted and data retrospectively collected between January 1st – June 30th 2019. Adult patients with open and closed complex ankle fractures (AO43/44) were included. Complex fractures included the following patient characteristics: diabetes ± neuropathy, rheumatoid arthritis, alcoholism, polytrauma and cognitive impairment. We obtained data on fixation choice and patient outcomes. Institutional approval was obtained by all centres, and statistical analysis was performed including propensity matching.ResultsFifty-six centres provided data for 1360 patients. The average age of the cohort was 53.9 years ±19 (SD) with a male/female ratio of 1:1.3. 920 patients were ASA 1/2, 440 were ASA 3/4; 316 had diabetes, and 275 were open fractures. Most fractures were AO44 (71.2%) and more commonly associated with diabetes (P<0.001), alcoholism (P<0.007), open (P<0.013), and advanced age (55.7 vs. 46.3). 1227 patients underwent primary-fixation (111 HFN), with the remainder treated with external-fixation (84 definitive). Of the 111 HFN, 35% underwent primary fusion. Wound complication and thromboembolic rates were greater in the HFN group compared to ORIF groups (P<0.003), being more evident in the HFN group with primary fusion even after propensity matching. However, 1081 patients were non-weightbearing post-op contrary to the BOAST guidance.ConclusionThis is the first National collaborative audit of complex ankle fractures. Hindfoot nails were used in 9% of patients and we observed more complications in this group when compared to other cohorts. Despite BOAST guidance, only 21% of patients undergoing operative management were instructed to fully weightbear post-operatively.

Does Local Aqueous Tobramycin Injection Reduce Open Fracture-Related Infection Rates?

To examine the effect of local aqueous tobramycin injection adjunct to perioperative intravenous (IV) antibiotic prophylaxis in reducing fracture-related infections (FRIs) following reduction and internal fixation of open fractures. Retrospective cohort study. Single academic Level I trauma center. Patients with open extremity fractures treated with reduction and internal fixation with (intervention group) or without (control group) 80 mg of local aqueous (2 mg/mL) tobramycin injected during closure at the time of definitive fixation were identified from December 2018 to August 2021 based on population-matched demographic and injury characteristics. The primary outcome was FRI within 6 months of definitive fixation. Secondary outcomes consisted of fracture nonunion and bacterial speciation. Differences in outcomes between the 2 groups were assessed and logistic regression models were created to assess the difference in infection rates between groups, with and without controlling for potential confounding variables, such as sex, fracture location, and Gustilo-Anderson classification. An analysis of 157 patients was performed with 78 patients in the intervention group and 79 patients in the control group. In the intervention group, 30 (38.5%) patients were women with a mean age of 47.1 years. In the control group, 42 (53.2%) patients were women with a mean age of 46.4 years. The FRI rate was 11.5% in the intervention group compared with 25.3% in the control group ( P = 0.026). After controlling for sex, Gustilo-Anderson classification, and fracture location, the difference in FRI rates between groups remained significantly different ( P = 0.014). Local aqueous tobramycin injection at the time of definitive internal fixation of open extremity fractures was associated with a significant reduction in FRI rates when administered as an adjunct to intravenous antibiotics, even after controlling for potential confounding variables. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Study of the Healing of Tibial Fractures Treated with Dynamic Intramedullary Nailing

Background: Dynamic nailing by placing only one screw on one side of the nail shortens the surgical time and reduces the complications during surgery and secondary dynamization. This study aimed to investigate the healing of dynamic intramedullary nailing (IMN) of tibial fractures. Methods: This cross-sectional study was done on 67 patients with dynamic IMN in 5th Azar Hospital, Gorgan, Iran, in 2015-2018. Complications, union time, Radiographic Union Score of Tibia Fracture (RUST) score, and Johner-Wruhs criteria were analyzed based on their grouping in AO classification. Results: The average age of the patients was 33.2 ± 13.0 years. Most of the fractures were closed type (71.6%), type C (43.4%). The mean healing time was 14.62 ± 4.38 weeks and RUST score was 8.90 ± 1.26. There was no significant difference between locations of fracture and the healing time or RUST score (P > 0.05). The healing time in the comminuted fractures (e.g., type C) and open tibial fractures was statistically longer than the simpler type (e.g., type A or B) and the mean radiological score in type C fractures was significantly lower (P < 0.05). The mean Johner-Wruhs criteria score of fractures was 46.31 ± 4.49, so that 61 patients had excellent results, four patients had good results, and two patients had fair results. Conclusion: Dynamic IMN of closed and middle third tibial fractures and simpler types of fractures (e.g., type A or B) have faster healing. Nevertheless, it is better to be more cautious for fixation of open or comminuted fracture (e.g., type C).

BACTERIAL CULTURES AND OUTCOME OF INTRAMEDULLARY INTERLOCKING NAIL IN OPEN DIAPHYSEAL FRACTURES OF TIBIAL

Background: The tibial shaft is one of the most common open long bone fractures; treatment improperly can lead to many serious complications and frequently cause permanent sequelae. Infection is one of the most common and disastrous complications of an open fracture. Therefore, determining the role of qualitative bacterial cultures in implementing the most effective antibiotics for opening tibial fractures and managing promptly and with precision is extremely important to avoid these complications and restore the patient's rehabilitation. Due to the paucity of articles exclusively dealing with this topic, we conducted a study to determine bacterial cultures and the functional outcome of intramedullary interlocking nailing in these patients. Objectives: This study assessed Bacterial cultures and the outcome of intramedullary interlocking nails in open diaphyseal fractures of the tibial. Materials and Method: A cross-sectional descriptive study was conducted on 32 patients with open diaphyseal fractures of tibial who were initially treated with thorough wound debridement and lavage, followed by surgical treatment with intramedullary interlocking nails. The qualitative method of antibiotic disc diffusion in agar (Kirby Bauer) is often applied to determine the susceptibility of bacteria to different antibiotics. All 32 patients were followed up, which was conducted using clinical criteria, and a radiographic was assessed using the RUST score. Results: In our study, the injury surgery interval was 14.54±6.304 hours. Staphylococcus aureus and Staphylococcus epiderdimis were common bacteria in open tibial fractures. The mean union time was 15.43±3.726 weeks, which was assessed by RUST score and clinical criteria. The functional outcome with Ketenjian and Shelton Criteria was excellent results in 28 (87.5%) cases and good outcomes in 4 (12.5%) cases. Conclusion: Using the intramedullary interlocking nail in open diaphyseal fractures of the tibial is an excellent procedure that leads to good results with reduced hospital stay, good range of motion, and low infection rate, leading to better union.

Lower Extremity Open Fractures Fix and Flap: Does Initial Management in Non-specialized Hospitals Really Compromise its Outcome?

Introduction Managing open lower extremity fractures is challenging, with potential complications such as amputation and infection. The aim of the study was to determine whether the time delay and initial treatment of the patients treated in a non-specialized hospital before being transferred to a dedicated level I trauma center led to a worse outcome. Methods Retrospective data from 44 patients (37 males and seven females) undergoing free tissue transfer for lower extremity open fractures from January 2017 to December 2022 were analyzed. Group A received primary care externally and was later transferred for definitive treatment (n=17, 38.6%), while group B received initial care at a level I trauma center (n=27, 61.4%). Surgical outcomes, complications, the duration of the hospital stay, and assessment times were compared. Various demographic variables, co-morbidities, prior interventions, and flap types were analyzed. Results Average age(A: 55.1±16.7;B: 38.7±19.8 years;p=0.041), overall hospitalization (A: 55.7±22.8; B: 42.8±21.3 days;p=0.041), and time to soft tissue reconstruction differed significantly between groups (A: 30.7±12.2; B: 18.9±9.3 days;p=0.013).Overall, 31.8% had multiple injuries without statistical differences between groups A and B (29.4% vs. 33.3%; p>0.05). There were no statistical differences between the groups in terms of major and minor complications and bone healing characteristics. Limb salvage was successful overall in 93.2% (A: 94.1%; B: 92.6%; P>0.05). Major complications occurred in 9.1%; three patients underwent major amputation (A: n=2; B: n=1). Minor complications were observed in 43.2% of patients (partial flap necrosis, wound dehiscence and non-union; A: 41.2%; B: 44.4%; p>0.05). Overall, 65.9% of patients (A: 64.7%; B: 66.7%; p>0.05) experienced uneventful bone healing, while 18.2% of patients (A: 23.5%; B: 14.8%; p>0.05) experienced delayed healing.Flaps used weremostly musculocutaneous(71.7%). Various assessed demographic characteristics, including age and presence of polytrauma, showed no significant influence on complications (p>0.05). Conclusion Although there is a significant difference in the time course of externally treated patients with open fractures, prolonged treatment is not associated with a higher complication rate or compromised bone healing outcome. Despite the findings, it is important to avoid delays and strive for interdisciplinary collaboration.

The spatial and geological characteristics of fault- and paleokarst-controlled carbonate-hosted reservoirs in the Tabei Uplift, Tarim Basin, China

Seismic interpretation and characterization of Middle Ordovician carbonates of the northern Tarim Basin in China reveal a series of deep-seated, sub-vertical conjugate strike-slip faults, together with sets of apparently layer-bound fractures striking parallel or orthogonal to the faults. Detailed stratigraphic analysis, well logging response interpretations (including formation microscanner images), coupled with core sample and thin section observations highlight vertical and lateral partitioning of fracturing and dissolution processes. Fracturing and dissolution development are most intense in grain-supported host rocks (grainstones, packstones) deposited in relatively shallow water conditions. Reservoir pore spaces vary systematically from north (Tahe) to south (Shunbei), which can be attributed to their proximity to a major regional angular unconformity with overlying Upper Devonian to Carboniferous sequences. Larger-scale dissolved fracture-cavity reservoirs are developed in the northern Tahe area due to the combined effects of faulting, surface karstification, and river system development close to the base Carboniferous erosion surface. Farther south, where the rocks lie farther from the paleoerosion surface, reservoir space is characterized by smaller, more structurally controlled open cavities bounded by fault slip surfaces, breccias, and open fractures. The observed interactions between paleokarstification intensity, tectonic controls, and host rock lithological layering—and their control over the observed reservoir complexity—are likely to occur in carbonate reservoirs worldwide.

Outcome of Honey and Ghee Dressing as Compared to Regular Dressing Materials: A Comparative Study

Background: Ghee and honey has been advocated and used as dressing for infected wounds by Sushruta (600BC). The gratifying results observed with the dressing have prompted this study which aims to establish its efficacy in chronic infected wounds over one year period A standardised ghee and honey dressing was used to treat: chronic post- operative wounds and infected per op wounds, Honey and ghee dressing markedly reduces the foul odour and discharge, significantly improving the quality of life. The study will tell us comparative result of honey and ghee dressing as compared to expensive vacuum dressing and the regular dressing materials. Innumerable Randomised Control Trials (RCTs) reported on honey dressing for infected wounds, there is substantial evidence that ghee and honey dressing has at least comparable results to other modes of treatment. The easy availability and low cost of this treatment makes it significant in developing countries. Specially in rural population, Required permission has been from the HOD of orthopaedics. Material and Methods: Total 20 patients with compound fracture and chronic infected wound, were studied during the period of March 2023 to June 2023 at BVP RMC Loni, Maharashtra. Honey and ghee were taken from a fresh sealed box in 50:50 portion according to size of wound and mixed well then it was applied on the wound directly and covered with gauge and, the dressing was changed is cleaned with sterile normal saline as compared to normal dressing materials ie betadin, povidon iodine ointment, spirit. All Patients data was collected and compiled in Microsoft excel and were statistically analysed using appropriate statistical test using SPSS software. Results: Majority patient were males. Mean duration of wound healing among honey and ghee dressing was 15.3 and of regular dressing was 8.9 days. Conclusion: Honey is one alternative solution that can be used for non-pharmacological therapy. Honey can be used as a topical dressing .........

Эффективность антисептической композиции при использовании спице-стержневых аппаратов наружной фиксации

The purpose of the study is to create and test a device that increases the effectiveness of treatment of open and sutured musculocutaneous wounds during open fractures and immersion osteosynthesis. To improve the healing process of open wounds and reduce possible complications, a group of inventions was developed, united by a common concept. One of the key elements of this group is the new composition. It helps create an aseptic environment for effective wound healing, reliably protects them from possible infections and contamination, and is also successfully used to prevent the development of purulent complications and postoperative osteomyelitis. To prepare it, you need to mix 150 mg of rifampicin, 4 mg of dexamethasone, 2.5 ml of 1 % dioxidine, 15 ml of 95 % ethyl alcohol, bringing the total volume to 100 ml using saline. This composition, used in combination with various external fixation devices, has outstanding antimicrobial, anti-inflammatory and wound healing properties. Another invention is an innovative device with a built-in dosing element, applicators and capillary tubes connected to a manifold, it provides precise and controlled delivery of the composition we have developed to the wound. This eliminates the need for frequent dressings and manual treatment of places where pins and rods penetrate or exit the body, which not only alleviates the patient’s discomfort, but also reduces the risk of developing secondary infections during the postoperative recovery period. In the period from 07/14/2021 to 05/31/2023, 15 mongrel dogs with open comminuted fractures of the right (8 heads) and left tibia (7 heads) were delivered to the veterinary clinic BION (Sevastopol), during the postoperative treatment of which they were tested antiseptic composition and modernized device. The results indicate the reliability and high efficiency of the resulting composition in the treatment and prevention of purulent-inflammatory processes in bones and soft tissues using pin-rod devices for fixation.

Modern concepts of interdisciplinary extremity reconstruction in open fractures

The orthoplastic approach involves the collaboration of orthopedic/trauma surgeons, vascular surgeons and reconstructive microsurgeons. In cases of complex limb fractures, the aims are to optimize blood flow, restore bone stability, reconstruct soft tissue defects, and enhance function and sensitivity. The early administration of antibiotics and atimely, high-quality debridement after initial interdisciplinary assessment are carried out. This is followed by fracture stabilization and temporary wound coverage in order to plan the definitive interdisciplinary procedure. This includes definitive osteosynthesis and soft tissue reconstruction, using local tissue transfer if feasible, or free tissue transfer in cases of extensive trauma zones. The orthoplastic approach allows for faster definitive stabilization, fewer operations, shorter hospital stays, lower complication and revision rates, higher cost-effectiveness and improved long-term function.

Structural geology of El Peñón karst system along an anticlinorium of the northern Andes, Colombia

Structural control is one of the most important factors in developing the karstic system since the fractures facilitate the infiltration and circulation of groundwater. This accelerates the mineral dissolution processes responsible for the formation of endo and exokarstic geomorphological features, such as sinkholes and underground cavities, among other landforms that characterize this environment. This study provides information on the structural geology of the El Peñón karstic system, considered one of the most significant and extensive karstic regions in Colombia. The karst is tectonically controlled by joints with a preferential NW-SE orientation and cleavage planes with an NE-SW trend, guiding the development of drainage systems, closed depressions, and underground cavities. The stress tensor obtained with a NW-SE direction (127°) explains the deformation in the area and its influence on the development of the karstic system. It was also established that the potential groundwater flow occurs through open fractures with a direction of 120°–130° (parallel to the stress tensor) and along the cleavage planes (40°–50°). The fracture patterns are characterized by intermediate intensity values, predominantly low fracture density, minimal lengths, and good connectivity between fracture planes.

CAN YOU PREDICT WHICH ‘ROUTINE’ CLOSED ANKLE FRACTURES REQUIRE EXTERNAL FIXATION RATHER THAN CAST IMMOBILIZATION? A RETROSPECTIVE MATCHED COHORT STUDY

IntroductionA subset of patients in cast awaiting fixation of ankle fractures require conversion to delayed external fixation (dEF). We aimed to evaluate the effect of delayed versus planned external fixation (pEF), then identify objective characteristics contributing to need for conversion.MethodWe extracted data from our booking system to identify all ankle external fixation procedures between 2010 to 2022. Exclusions included open fractures, the skeletally immature, and pilon or talus fractures. Fractures were classified using the AO/OTA classification, then a matched cohort was identified based on fracture classification. We compared the planned, delayed and matched cohorts for demographics, posterior malleolar fragment (PMF) ratio, and degree of displacement at presentation.ResultsWe identified 25 pEF, 42 dEF, and 67 matched patients. Ankles with dEF had a 3.8 day longer time to ORIF from presentation than those who had pEF, and had an infection rate of 9.5%, compared to 4% in the pEF group. Two patients in the dEF group required further operative intervention. There were no infections or reoperations required in the pEF or matched groups. The dEF group were more likely to have ≥2 reductions (OR 4.13), a PMF ratio of >0.23 (OR 5.07), and have increased displacement at time of injury on lateral (32% vs 19%) and AP (62% vs 36%) radiographs.DiscussionOur retrospective study highlights the longer time to operation and increased infection rates of patients who do not get timely external fixation. We propose a series of objective parameters that predict failure of cast treatment and guide the surgeon to consider planned external fixation in some ankle

LACTOFERRIN AS AN ADJUVANT ANTIMICROBIAL IN BATTLEFIELD-RELEVANT OPEN FRACTURES

IntroductionMajor trauma during military conflicts involve heavily contaminated open fractures. Staphylococcus aureus (S. aureus) commonly causes infection within a protective biofilm. Lactoferrin (Lf), a natural milk glycoprotein, chelates iron and releases bacteria from biofilms, complimenting antibiotics. This research developed a periprosthetic biofilm infection model in rodents to test an Lf based lavage/sustained local release formulation embedded in Stimulin beads.MethodSurgery was performed on adult rats and received systemic Flucloxacillin (Flu). The craniomedial tibia was exposed, drilled, then inoculated with S. aureus biofilm. A metal pin was placed within the medullary cavity and treatments conducted. Lf in lavage solutions: The defect was subject to 2× 50 mL lavage with 4 treatment groups (saline only, Lf only, Bactisure with Lf, Bactisure with saline). Lf embedded in Stimulin beads: 4 bead types were introduced (Stimulin only, Lf only, Flu only, Lf with Flu). At day 7, rats are processed for bioluminescent and X-ray imaging, and tibial explants/pins collected for bacterial enumeration (CFU).ResultsRats without treatments established a mean infection of 2×106 CFU/tibia. 4 treatment groups with a day 0, one-off lavage demonstrated >95% reduction in bacterial load 7 days post-op, with a reduction in CFU from 1×106/tibia down to 1×104/tibia. There was no statistically significant difference between each group (p = 0.55 with one way ANOVA). The stimulin bead experiments are ongoing and complete results will be obtained in the end of July.ConclusionsThis research demonstrated a clinically relevant animal model of implanted metalware that establishes infection. No additional benefit was observed with a one-off, adjuvant Lf lavage during the initial decontamination of the surgical wound, compared with saline alone, and in combination with the antiseptic Bactisure. This animal model provides the foundation for future antibiofilm therapies.

Supraclavicular Block Using Ultrasonography (USG) Guidance in Patients with Moderate Radius Ulna Fractures Mitral Regurgitation Undergoing ORIF (Open Reduction and Internal Fixation): A Case Report

Background: Open fractures of the radius and ulna in elderly patients are conditions that require fast and appropriate treatment. Open reduction internal fixation (ORIF) is a common treatment option, but in elderly patients, general anesthesia may be high risk. Supraclavicular brachial plexus block is an effective and safe regional anesthetic option for ORIF in elderly patients. Case presentation: We report the case of a 71-year-old man with an open fracture of the left third radius and middle ulna who was planned for ORIF. The patient had comorbid hypertension and reduced left ventricular function. Supraclavicular brachial plexus block was performed using 0.5% bupivacaine (10 mL) and 2% lidocaine (10 mL). The patient did not complain of pain during the operation and recovered well. Conclusion: Supraclavicular brachial plexus block is an effective and safe regional anesthetic option for ORIF in elderly patients with open fractures of the radius and ulna.

Evaluating Fibular Intramedullary Nails vs Traditional Plating in Geriatric Ankle Fractures: A 12-Year Single-Center Retrospective Study.

This study evaluates the outcomes of fibular intramedullary nails (IMNs) compared to traditional plates and screws (PS) in the surgical treatment of unstable ankle injuries in patients aged ≥65 years. We conducted a retrospective study involving 32 elderly patients with unstable ankle fractures treated with IMNs from 2010 to 2022. A comparison was made with 125 case-control patients treated with PS during the same period. Outcomes compared included postoperative wound and nonwound complications, surgical reduction, union rates, implant removal rates, and the Olerud Molander Ankle Score (OMAS) at a minimum follow-up of 2 years. The IMN group had a higher incidence of high-energy injuries, open fractures, concomitant surgery, and perioperative transfusion requirements than the PS group. Additionally, the IMN group developed fewer wound-related (3.1% vs 20% in the PS group, P = .043) and non-wound-related complications (18.8% vs 39.2% in the PS group, P = .030). Both groups had similar initial weightbearing restrictions, fracture union times, mean OMAS scores, rates of malunion or nonunion, and delayed implant removal times. Notably, there were significant differences in the quality and adequacy of mortise alignment between the groups (good: 53.1% in IMN group vs 79.2% in PS group, fair: 46.9% in IMN group vs 20.8% in PS group, P = .006). Although the IMN group had an inferior outcome in the quality and adequacy of mortise reduction compared with the PS group, elderly patients with ankle fractures treated with IMN showed comparable functional outcomes to those treated with PS but with lower complication rates. Future research in this area will provide vital information for developing optimal treatment strategies, thereby improving the overall care of elderly patients with ankle fractures.

Experimental Study on the Effect of Rock Mechanical Properties and Fracture Morphology Features on Lost Circulation

Summary At present, lost circulation remains a complicated drilling problem in fractured formations that needs to be addressed urgently. However, the influence of actual rock mechanical properties (RMP) and fracture morphological features (FMF) on lost circulation is easily ignored in the current research on leakage mechanism and evaluation, which may lead to deviation from the analysis results, thus affecting the success rate of plugging treatments. Therefore, the complicated effects have been investigated using the improved plugging experimental instruments in this paper. The results indicate that both RMP and FMF have a prominent influence on the plugging and sealing effects of plugging slurries. This research suggests that the bridging and plugging capabilities of the slurry can be improved by increasing the type and amount of lost circulation materials (LCM). Moreover, depending on the fracture morphology difference, the same plugging slurry will have different plugging effects on the same width-size opening fracture channel. In addition, a novel evaluation method is developed to assess the effective sealing ability of plugging slurry against formation fractures, which has been successfully applied in the field. To the best of our knowledge, this is the first evaluation method that investigates simultaneously the mechanical properties of rocks and fracture characteristics of formations. The novel evaluation method incorporates the critical parameters of the lost circulation effect into the design of the plugging evaluation model. Thus, the proposed method can be used to quantitatively evaluate the plugging capability of the LCM and slurries and the loss capacity of the loss channels. However, the higher plugging coefficient (λ) of the slurry does not necessarily mean that the plugging slurry has a stronger plugging capacity (SP). Adopting the suitable fracture channel model can avoid overestimating or underestimating the plugging capability of the LCM slurries. Therefore, it is necessary to improve the formula design of the LCM slurry in combination with the geological engineering background. This perception has significant implications for the analysis of the lost circulation mechanisms and the optimization formula design of the plugging slurries.

A review of 10 patients treated with the masquelet technique and microsurgical technique combined for Gustilo type III open tibial fractures

BackgroundOpen tibial fractures often include severe bone loss and soft tissue defects and requires complex reconstructive operations. However, the optimal treatment is unclear.MethodsThis 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.ResultsWe 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.ConclusionsOur 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.

ROLE OF DYNAMIZATION IN INTRAMEDULLARY NAILING OF TIBIA

Objectives: This study aims to know the functional outcomes of intramedullary nailing (IMN) osteosynthesis in long bone shaft fractures among adult patients with stable internal fixation and union. Additionally, it seeks to assess the specific and general complications experienced by both groups. Methods: The study was conducted at the Department of Orthopedics, Government Medical College, and Rajindra Hospital in Patiala, spanning from March 2021 to December 2022. It was a prospective, manipulative, controlled study involving a total of 40 cases of tibia diaphyseal fractures that were presented to the orthopedics department. Fractures were classified according to the AO fracture classification. Results: The average time for union in the dynamic group was 15.60 weeks (with a standard deviation of 1.27). A significant statistical difference was observed, favoring the dynamization nailing group (p<0.01), indicating a strong trend toward faster union. Out of the 40 patients, 16 (40%) experienced at least one complication. In conclusion, dynamic IMN osteosynthesis permits micromotion between fracture fragments, directly stimulating bone formation and the development of callus. Conclusion: For closed or open tibial diaphyseal fractures with minimal comminution (types A and B based on the AO classification) up to Gustilo 3A, dynamic IMN assembly is considered a safe and effective treatment option.

The Applicability of Dynamic External Fixator in a Prospective Evaluation of Open Tibial Fracture Treatment.

This prospective study assessed the clinical and radiological outcomes of open tibia fractures treated with a dynamic external fixator. Twenty-five patients underwent surgical debridement and stabilisation with a dynamic external fixator between November 2016 and April 2022. Regular follow-up evaluated bone healing progression. Favourable outcomes were demonstrated in 20 patients. However, there were three cases of non-union, two of which subsequently deformed, and two cases of pin site-related infection. There were no fracture site infections. This study demonstrates the use of dynamic external fixation in the treatment of open tibia fractures. The low incidence of complications suggests its effectiveness and potential. Bezerra BS, Araujo TA, Cardonia GG, et al. The Applicability of Dynamic External Fixator in a Prospective Evaluation of Open Tibial Fracture Treatment. Strategies Trauma Limb Reconstr 2024;19(1):36-39.