External Fixation Of Open Fractures Research Articles

Pin tract infection after uniplanar external fixation of open fractures at a national, teaching and referral hospital

Background: Pin tract infection is the most common complication of external fixation accounting for 43% of complications. The presence of a pin tract infection leads to subsequent pin loosening and fixation failure. It also delays conversion of an external fixator to internal fixation until clearance of the infection is achieved. The incidence of pin tract infections in our setting is not known. This study was aimed at determining the incidence and microbe profile of pin tract infection in patients who have undergone uniplanar external fixation following open fractures at Kenyatta National Hospital.Methods: Consecutive sampling of patients who had undergone uniplanar external fixation at Kenyatta National Hospital (KNH) was done between September 2016 and December 2016. 73 patients were recruited. Data concerning presence of pin tract infection was collected. Patients with discharging sinuses had a culture and sensitivity done while those with major pin tract infection had immediate x-rays done to rule out radiological changes.Results: Incidence of pin tract infection was 87.7% (64 of 73 patients). Staphylococcus aureus (30.2%) and coagulase negative staphylococci (16.3%) were the commonest causative organisms.Conclusion: The incidence of pin tract infection after uniplanar external fixation is high. Better surgical technique and pin-site care is recommended. Staphylococcus aureus is the leading cause of pin site infection.

Pin-Tract Infections Following External Fixation of Open Fractures

Background: Pin-tract infection is a major complication of external fixation which in some cases compromises the stability of ty of pin-tract infections in open fractures treated by external fixation. Methodology: This is a retrospective study that reviewed patients who underwent external fixation with unilateral fixator for open fractures in our center between February 2009 and March 2010. Wound swabs for culture and sensitivity were obtained from patients with clinical evidence of pin-tract infections. Pin-tract infection was graded according to Paley's method. Results: A total of 102 patients who had external fixation for open fractures were reviewed. The male female ratio was 1.4:1. Open fractures of tibia (73.5%) were found to be the commonest. This was followed by radius (15.1%), humerus (8.2%), and femur (4.1%). Positive cultures were obtained from 32 samples out of 35 and staphylococcus aureus was the commonest organism isolated. Drainage (51.4%) was found to be the commonest pin related complication. Conclusion: pin-tract infection is a serious complication associated with external fixation and meticulous surgical techniques and proper pin care should be ensured in order to minimize these pin related complications.Key Words External fixation, infection, open fractures, pin-tract

The effect of HIV on early wound healing in open fractures treated with internal and external fixation

There are 33 million people worldwide currently infected with human immunodeficiency virus (HIV). This complex disease affects many of the processes involved in wound and fracture healing, and there is little evidence available to guide the management of open fractures in these patients. Fears of acute and delayed infection often inhibit the use of fixation, which may be the most effective way of achieving union. This study compared fixation of open fractures in HIV-positive and -negative patients in South Africa, a country with very high rates of both HIV and high-energy trauma. A total of 133 patients (33 HIV-positive) with 135 open fractures fulfilled the inclusion criteria. This cohort is three times larger than in any similar previously published study. The results suggest that HIV is not a contraindication to internal or external fixation of open fractures in this population, as HIV is not a significant risk factor for acute wound/implant infection. However, subgroup analysis of grade I open fractures in patients with advanced HIV and a low CD4 count (< 350) showed an increased risk of infection; we suggest that grade I open fractures in patients with advanced HIV should be treated by early debridement followed by fixation at an appropriate time.

Pin-Site Myiasis: A Rare Complication of a Treated Open Fracture of Tibia

Pin-site myiasis is a rare complication of external fixation of open fractures of the tibia. Case report and literature review. A 32 year-old man with a history of alcohol and drug abuse presented with an open fracture of the middle third of the fibula and tibia (Gustilo type IIIA) after a motor vehicle crash. Definitive surgical correction of the fracture was made with the insertion of an external skeletal fixator, type Baummer, with 2 bars, 6 pins, and 12 rotules. After three weeks, he presented again with a primary complaint of purulent secretion and maggots at the distal pin site. On removal of the pin, significant destruction of peripheral tissue was evidenced, with a wound approximately 5 cm diameter, from which 105 maggots were extracted, being identified as Cochliomyia hominivorax. There have been no previous reports of myiasis involving an external skeletal fixation and pin, and only one similar case has been reported in a patient with a halo orthosis for the management of a gunshot wound of the neck. As in that case, presumably, in our patient, myiasis occurred via the small infected wound adjacent to the distal pin. Adequate treatment for myiasis requires complete removal of the maggots, as well as antimicrobial therapy.

Tibial Nonunion: Treatment Alternatives.

Because the spectrum of injuries to the tibia is so great, no single method of treatment is applicable to all nonunions. Therefore, it is important for surgeons who treat tibial nonunions to be skilled in several different methods of treatment. In patients with significant deformities, electrical stimulation, isolated fibular osteotomy, and bone grafts alone are unsatisfactory treatment options. In aseptic nonunions, the use of intramedullary nailing or compression plating appears to have many advantages. In previously closed and selected grade I and grade II open fractures, reamed intramedullary nailing is a safe and effective method of treatment. Because of the risk of infection, reamed nailing is not recommended after external fixation of open fractures. In these cases as well as others, the authors prefer plate osteosynthesis. With few exceptions, the plate should be placed, under tension, on the convex side of the tibia. Used in this fashion, the plate can assist in correction of any deformity and can also provide stable internal fixation. Half-pin external fixation is used primarily in the management of infected fractures. Ilizarov and other small-wire circular fixators have proved effective in treating complex-composite deformities associated with sepsis, bone loss, shortening, angulation, or malrotation. Amputation may be warranted if a functional limb cannot be achieved.

Alternative external fixation for open fractures of the lower leg.

A locally made cheap external skeletal fixator using wood and its use in seven patients with an open fracture of the lower leg together with soft-tissue injury are described. The application of the external fixator in such fractures is a good example of appropriate technology and facilitates the daily hygienic nursing care of wounds.

Nonunion of the tibia treated with a reamed intramedullary nail.

Forty-seven tibial nonunions were treated with a reamed intramedullary nail. Initially, there were 14 (30%) closed and 33 (70%) open tibial fractures. The initial fracture management consisted of casts in 12 (26%) patients, Ender or Lottes nails in nine (19%), and external fixation in 26 (55%). The time from injury to nailing averaged 31.5 weeks. All but one fracture was nailed using a closed technique (98%). Twenty-six patients were initially managed with external fixation. Duration of fixation averaged 11 weeks, and the time from fixator removal to nailing averaged 24 weeks. Patients were followed for an average of 18.7 months after nailing. Forty-two of the 47 (89%) nonunions united uneventfully. Infection developed in six (13%) patients, five of which occurred in previously open fractures treated with external fixation. After one or more procedures, these nonunions consolidated without apparent infection. Reamed intramedullary nailing is a safe and effective method of treatment for tibial nonunions of previously closed fractures and prior open fractures that have been treated with Ender or Lottes nails. Because of the risk of infection, we do not recommend its use after external fixation of open fractures.

Treatment of open fractures of the tibial shaft

A randomized, prospective study comparing Ender nailing with external fixation for open fractures of sixty-three tibiae (sixty patients) was undertaken. Ender nailing proved to be at least as effective as external fixation with respect to seven parameters: time to union, tibial alignment, total number of operations, ranges of motion of the knee and ankle, pain, presence of infection, and complications. Ender nailing is a safe alternative to external fixation for grade-I and grade-II open fractures. It should not be used for comminuted fractures, which might shorten about the nails.

Complications of external fixation of open fractures of the tibia

Forty-two cases of open fractures of the tibia treated by external fixation are presented. Forty-three per cent of patients developed sepsis around one or more pins. Pin track sepsis occurred in 78 per cent of cases involving transfixion pins through muscle and bone but in only 17 per cent of cases using transcutaneous half-pins. Malalignment of more than 5 ° in any plane was seen in 38 per cent of cases, almost half of which increased in plaster after removal of the fixator.

Treatment by External Fixation of Open Fractures Associated with Severe Soft Tissue Damageof the Leg

External fixation is the treatment of choice for fractures of the leg involving severe damage to the soft tissue. Each of the various patterns of application has advantages and disadvantages. Based on various biomechanical studies and clinical experience, the authors use a right-angle arrangement for the screws. If the type of fracture permits, internal and external fixation may significantly increase stability. During the period from 1978 to 1980, 56 patients with second- and third-degree open fractures were treated. A combination of external and internal fixation was used in 42 patients. Of the 44 patients re-evaluated at follow-up examinations, 19 had returned to unrestricted weight-bearing within 19.8 weeks. If no signs of bony union are noted ten to 12 weeks after the initial operation, cancellous bone grafting and internal fixation instead of external fixation are indicated. Twenty-three patients were fully weight-bearing an average of 14 weeks after internal fixation and cancellous bone grafting. Two patients had difficult problems and did not return to full weight-bearing until about 45 weeks after operation.