Open Fractures Research Articles

Erratum. Contemporary management of pediatric open skull fractures: a multicenter pediatric trauma center study.

Erratum. Contemporary management of pediatric open skull fractures: a multicenter pediatric trauma center study.

Lower Limb Comprehensive Reconstructive Surgery: Experiences from an Orthopedic Teaching Unit

Abstract Introduction: The burden of open extremity fractures is well recognized in placing a burgeoning demand on an already exhausted medical facility in low- and middle-income countries. This study aims to evaluate the functional outcome following “orthoplastic management” by orthopedic surgeons trained in limb reconstruction surgery. Methodology: Adult patients with open lower limb injuries treated from January 1, 2022, to December 30, 2022, who underwent single or staged fixation and reconstruction procedures were identified. Patients with Gustilo–Anderson type IIIB fractures requiring skeletal stabilization with soft-tissue cover were included. Polytrauma patients requiring multidisciplinary surgical attention were excluded. A team of orthopedic surgeons trained in limb reconstruction was involved in the management. Inpatient and outpatient department follow-up by the treating team was done to document complications (infections, reoperations, and graft failures) and functional outcomes using the Lower Extremity Function Score. The duration of mean follow-up was 1 year since index surgery. Results: A total of 24 adult patients with open lower limb injuries with preoperative Ganga Hospital Score (GHS) were included. Decision toward fixation with primary closure or further reconstruction was made collectively. The gray zone (GHS score of 15–16) of patients was more aggressively managed with emphasis on salvage. Additional reconstructive procedures were carried out based on the assessment at consequent follow-up. Three patients had a suboptimal joint function (less than functional range of motion for the involved joint) due to the resultant loss of compartment(s) and joint contracture. Five patients were retaken to the theater for further supplementary or corrective procedures following the index, definitive surgical procedure (bone grafting, partial flap loss, and fixator readjustment). Conclusion: Good-to-excellent functional outcome was demonstrated with the “orthoplastic approach” where skeletal stabilization as well as soft-tissue reconstruction was performed by trained orthopedic surgeons. This study demonstrated that orthoplastic surgery is a safe and effective method of limb salvage.

Salvage of a comminuted proximal tibial polymicrobial infected non-union with antibiotic loaded bio-composite and intramedullary nailing: a case report

Background. Management of open proximal metaphyseal fractures poses a significant challenge and is fraught with complications. These injuries are severe, often accompanied by extensive soft tissue and vascular damage, leading to high risks of infection and long-term disability. Case presentation. A 72-year-old male was severely injured in a road traffic accident. Plain X-rays and CT angiogram identified a comminuted proximal tibial fracture with transection of the popliteal artery and vein. Initial emergency treatment included fasciotomies, external fixation, and vascular primary repair. On the 12th day of admission, the patient underwent open reduction and internal fixation (ORIF) with dual plate fixation using a two incision technique. A plastic surgeon performed skin grafting, harvested from the patient’s thigh, to allow closure of his fasciotomy wounds immediately following ORIF. Four weeks post-operatively, the patient developed a wound breakdown over the lateral fasciotomy site, exposing the metal plates with a small defect developing on the medial fasciotomy wound in tandem. The patient’s course was further complicated by persistent polymicrobial infections. Over 6 months of antibiotic regimes, operative intervention was ultimately required. All of the infected metal implants were removed, the non-union sites were aggressively debrided. The tibial canal was reamed to prepare for a tibial nailing. An antibiotic loaded bio-composite was then inserted through the non-union sites into the canal followed by an intramedullary nail. A blocking screw was used to address the procurvatum deformity in the sagittal plane. The patient currently shows signs of recovery, mobilizing over short distances, weight-bearing with assistive aids and with healing wounds and early signs of callus formation on recent CT scans and plain X-rays. Conclusions. The management of complex tibial fractures with vascular involvement demands an aggressive multidisciplinary approach and continuous adaptability in treatment plans to address the evolving challenges of such severe injuries. This case exemplifies the utility of injectable antibiotic-loaded bio-composites in a limb-salvage setting and their ability to provide high doses of local antibiotics to an infection site which, in conjunction with appropriate stable fixation and systemic antibiotics, can aid in eradicating and treating fracture-related infections.

Artificial deformity creation in treatment of soft tissue wounds and lower leg bones defect: a case report

Background. The problem of treating wounded patients with defects of soft tissues and bones of the extremities continues to be relevant. One of the ways to close soft tissue defects, especially in case of bone tissue loss, after open fractures of the extremities is acute shortening and creation of artificial angular deformity of the segment. The aim of the study — to demonstrate the possibilities of acute shortening and angulation of the segment as a technique to replace soft tissue and bone defects in treatment of a patient with a gunshot wound to the lower leg. Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in soft tissues and bones of the lower leg in the middle third. To reduce the wound size, acute shortening and angulation of the lower leg was performed. The intentional angular deformation was 24º, shortening — up to 8 cm. The residual soft tissue wound defect was closed with local tissues and split skin autograft. The tibia was fixed by the Ilizarov hinge-distraction apparatus with following gradual correction of the angular deformity. After that, one performed osteotomy of the tibia in order to eliminate shortening with the Ilizarov method (the distraction rate of 1 mm per day). After restoring the length of the lower leg, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from a displaced fragment. At a follow-up examination, in 18 months after the injury the patient walks with full weight bearing on the injured limb without any additional means of support, continues to perform military service duties in accordance with his position. Conclusions. The presented clinical case demonstrates that acute shortening of a limb segment with creation of artificial angular deformity is an effective method for temporary closure of a gunshot defect of soft tissues. The technique allowed closing critical soft tissue defect of the lower leg and restoring the anatomy (length) of the segment. Consequently, one was able to achieve satisfactory treatment results and restore the functions of an injured limb. Besides, acute temporary shortening technique eliminated the need to perform technically sophisticated and lengthy microsurgical reconstructions, which are associated with a flap replacement for closure of soft tissue defects in a shotgun fracture area.

Lowering of the Patella — prevention and treatment of a rare complication during leg lengthening: a case report

Background. Changes in the level of the patella position are a well-known complication of knee replacement, reconstruction of the anterior cruciate ligament, high tibial osteotomy and consequences of injuries. However, this problem has not been disclosed in the literature in relation to distraction osteogenesis using the Ilizarov method. The aim of the study is to describe such a rare iatrogenic complication as patella baja during limb lengthening by the Ilizarov method using a clinical case as an example. Case description. In 2017, a 17-year-old teenager was injured in a head-on collision of cars at high speed. The patient was diagnosed with an open fracture of the left femur and fibula and tibia of the left leg. He was treated in another clinic using the Ilizarov apparatus for osteosynthesis of the femur, tibia and proximal osteotomy of the tibia to move the bone to fill the distal bone defect. At the end of the treatment, the patient had a moderate limitation of the knee flexion (180-80°). In 2018, the patient was admitted to our clinic due to osteomyelitis at the level of the consolidated fracture. A new resection of the osteomyelitis lesion and proximal osteotomy for bifocal osteogenesis were performed. During the treatment, limitation of knee flexion (180-120°) was developed and radiographic signs of low position of the patella were obtained. Given the progression of patella baja (the Caton-Deschamps index = 0.51), we were forced to return the patient to the operating room to restore the correct height of the patella. Conclusions. The presented clinical case emphasizes the need for a more thorough assessment of the patella height after surgical treatment on the proximal tibia using the Ilizarov method. It is also noted that it is important to conduct a control MRI, which allows for a more detailed study of the initial position of the anterior tibial tubercle. In our case, early detection of complications allowed us to achieve complete recovery without any consequences.

Usefulness of Platelet-rich Fibrin in Open Fractures of Tibia: A Randomised Comparative Pilot Study

Background and Aims: Platelet-rich fibrin (PRF), rich in growth factors and cytokines, found useful for bone healing in animal studies, has paucity of literature on open fractures in humans. This randomised comparative interventional study aimed to find out the role of PRF in wound healing and fracture union in open fractures of tibia. Material and Methods: Random computerised allocation of 14 open tibial shaft fractures managed with an external fixator were done into PRF and non-PRF groups. Autologous PRF injected at fracture site, with PRF gel over open wounds in the PRF group, was compared with conventional standard treatment in the non-PRF group. Wound assessment on day 3, day 7 and weekly till complete wound healing and radiographs for fracture union at 3, 6, and 12 months were done in both groups. The statistical analysis was done using an unpaired t-test (wound size assessment) and chi-squared test (fracture union), using SPSS version 25. Results: Fractures union in PRF group 7/8 (87.5%) was better than 3/6 (50%) in non-PRF group. External fixators were removed 4 weeks earlier in PRF group. Wound healing time, though not statistically significant, was faster in PRF group (36.25±3.03 days) compared to non-PRF (42±7 days), even with larger wound size in PRF group (7.87±1.43 cm 2 ) than non-PRF group (7.5±1.5 cm 2 ). Conclusions: Results of injectable PRF at fracture site and PRF gel over the wound are encouraging, found to be safe, with faster wound healing and better fracture union in the small sample size of this pilot study.

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

PurposeSevere 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.MethodsData 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.ResultsAll 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).ConclusionsFVFG 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 evidenceLevel 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.

Experimental and Histological Validation of Nanostructured Products Use in Maxillofacial Surgery

The aim of the study is using experimental histological techniques to validate the beneficial potential of specific medical devices made of nanostructured titanium, and compare their effect with factorymade products currently applied in maxillofacial surgery. Material and methods. The study involved 50 sexually mature male Chinchilla rabbits. An open fracture of the lower jaw was simulated in the animals. In the 1st series of the experiment, the fragments were fixed using nanostructured miniplates and miniscrews made of Grade 4 titanium. In the 2nd series, they were fixed with standard miniplates and miniscrews from Konmet LLC. The material for the study was taken on the 7th, 14th, 21st, 28th and 40th days after the operation. In all series the object of the study was the extirpated lower jaw in the fracture area. The prepared histological sections were stained with Mayer's hematoxylin and eosin. The immunohistochemistry technique was used to identify cells with signs of proliferation (synthesizing the Ki67 protein), to assess the expression of the synthesis of proteins p53, caspasa 3 and the anti-apoptotic protein bcl-2. The surfaces of titanium structures were studied by scanning electron microscopy. The results were processed statistically. Results. The study investigated the effect of miniplates and miniscrews made of nanostructured and standard titanium on rabbits. The data obtained revealed the nature of the proliferative and apoptotic potentials of osteoblasts in the regenerate, and also indicated an increase in the ratio of the number of cambial cells and cells with an apoptotic dominant in the zone contacting with the nanostructured surface of the titanium screw compared to the titanium screw manufactured by Konmet LLC. Taken together, the obtained data indicate that the use of nanostructured titanium Grade 4 for the production of miniplates and miniscrews has an optimizing effect on reparative osteogenesis. The mechanism of this effect is determined by the presence of osseointegration properties of titanium. Conclusion. Nanostructured titanium is advisable to use for the production of implants, reconstructive titanium plates and other products for bone grafting.

Complex trauma sequelae: Mycobacterium goodii and Priestia endophytica Hardware infection in a patient with Ehlers-Danlos syndrome

A 26-year-old man with Ehlers-Danlos syndrome, recurrent otitis externa, and chronic otitis media sustained a left lower extremity amputation and open femur fracture with internal hardware fixation after a motor vehicle collision in Arizona. He presented to the emergency department at our institution with severe left leg pain and purulent discharge despite receiving two unidentified antibiotics upon discharge. Evaluations revealed an abscess and malunion of the femur. Initial cultures yielded scant Priestia endophytica, leading to daptomycin treatment. His condition worsened until Gram-positive bacilli identified as Mycobacterium goodii, a rare nosocomial mycobacterial species, were found. Significant improvement occurred with appropriate antibiotics. This case highlights the challenges in diagnosing and managing M. goodii infections in immunocompromised patients with orthopedic complications and notes P. endophytica as a previously unreported, possibly opportunistic human pathogen.

Comparison of Early Versus Late Debridement Outcomes in the Management of Open Distal Radius Fractures

The optimal timing for surgical treatment of open distal radius fractures remains an area of debate. The purpose of this study was to examine the outcomes of open distal radius fractures treated surgically before or after 24 hours. A multicenter retrospective review was performed on all open distal radius fractures treated over 11 years. Patient demographics, injury mechanism, and initial treatment were recorded. Fracture severity was graded by the Gustilo-Anderson classification. Comparisons were made between those treated surgically within and after 24 hours. Outcomes examined included infection, revision surgery, osteomyelitis, and nonunion. A total of 230 cases met the inclusion criteria. The cohorts of early and delayed surgical intervention were similar with regard to preoperative demographics. The most common mechanism of injury was motor vehicle accident. Approximately 40% of cases were graded as type I, 40% as type II, and 20% as type III. Mean time to debridement in the group treated after 24 hours was 5 days. A mean postoperative follow-up of greater than 6 months was obtained in both cohorts. Similar outcomes were found between cohorts with respect to postoperative infection, revision surgery, osteomyelitis, and nonunion. Similar outcomes with regards to infection, revision, osteomyelitis, and nonunion were found between open distal radius fractures treated emergently versus those managed in a delayed fashion. Patient- and injury-specific factors are important in dictating care. Prognostic IIB.

Timing of radiographic healing for distal femur fractures treated with intramedullary nails.

This study aimed to profile modified Radiographic Union Scale for Tibia (mRUST) scores over time in distal femur fractures treated with intramedullary nails and identify predictors of radiographic union timing and delayed progression. Design: Multicenter retrospective cohort study. Ten Level I Trauma Centers. The inclusion criteria were patients with distal femur fractures (OTA/AO 33A and 33C) treated with intramedullary nails, with a minimum follow-up of one year or until radiographic union or reoperation. The exclusion criteria were fractures treated with combination nail-plate constructs, pathologic fractures, and patients under 18 years old.Outcome Measures and Comparisons: The primary outcome was the mRUST score at 3, 6, and 12 months post-operatively. Receiver operating characteristic (ROC) curve analysis identified the optimal 3-month mRUST score predicting reoperation. Multivariable models were used to identify predictors of radiographic union timing and delayed progression. The study included 155 fractures in 152 patients, with a mean patient age of 51 and a mean follow-up of 17 months. A 3-month mRUST score of ≤8 predicted reoperation with a PPV of 25%, and a NPV of 99%. The timing of radiographic union was associated with tobacco use (1.2 months later; p = 0.04), open fracture (1.4 months later; p = 0.04), and the use of topical antibiotics (2.1 months longer; 95% CI: 0.33 - 3.84; p = 0.02), however topical antibiotics was at high risk of being confounded by injury severity. Delayed progression to fracture healing, wherein the most rapid radiographic healing occurs more than 3 months post-operatively, was predicted by chronic kidney disease (p < 0.01). A 3-month mRUST score >8 suggests a very high likelihood of avoiding reoperation for nonunion.Tobacco use and open fractures were associated with a longer time to radiographic union. Chronic kidney disease is associated with a delayed radiographic progression, suggesting a need for adjusted expectations and management strategies in these patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sociodemographic factors and its correlation with schema modes and PTSD among orthopedic trauma survivors

ObjectiveThe study aimed to examine the correlation between sociodemographic factors, schema modes, and Post-Traumatic Stress Disorder (PTSD) in individual who have experienced trauma. MethodA total of 137 patients participated in the study, including 104 men, and 33 women. The Urdu- translated Schema Mode Inventory and the Clinician Administered PTSD Scale (CAPS for DSM-5) were used. ResultsThe study found significant positive correlation between demographic factors such as age, gender, education, economic status, and type of injury with PTSD symptoms in orthopedic trauma survivors. The results further indicated, that gender (both male and female), level of education, and socio-economic status were significantly positive associated with PTSD symptoms. While, 50.7 % of patients with closed fractures and 62.1 % of those with open fractures showed PTSD symptoms, no clear association was found between PTSD symptoms and the type of trauma experienced. Additionally, female patients showed significantly higher PTSD symptoms than male. The finding also revealed that child mode, and maladaptive punitive parents had significant impact on PTSD development, whereas, maladaptive coping styles and adaptive schemas had no influence on PTSD symptoms.Moreover, patients with grade-I fractures and intentional injuries showed significantly higher maladaptive schema modes. ConclusionThe study concluded that demographic characteristics, such as gender, education and socioeconomic status play an important role in development of PTSD symptoms in orthopaedic trauma survivors. In addition, maladaptive schema modes significantly contribute to PTSD symptoms, while coping styles and adaptive schema modes have no impact.

Orthoplastic Reconstruction of Distal Tibia High-Energy Fractures Using a Circular External Fixator—A Systematic Review

Background: Compound fractures of the distal tibia (with or without the middle third) represent a challenge for orthopedic and plastic surgeons because of the scarcity of available soft tissue reconstruction and the important comminution of the fractures that usually appear. Methods: The design of this study is based on the PRISMA guidelines. Databases were searched for articles published and available until the first half of 2023. Articles that presented the evolution of patients treated by combining circular external fixators with reconstructive methods were selected. Results: After searching the literature using keywords, we obtained 3355 articles, out of which 14 articles met all the inclusion criteria, with a total number of participants of 283. The bone loss varied between 0.7 and 18.2 cm, while the soft tissue defect was between 3/3 cm and 16/21 cm. The average period of fixation ranged from 4 to 22.74 months. The most used reconstruction methods were 80 free flaps and 73 pedicled flaps out of 249 interventions. Complete flap loss appeared only in 3/283 patients. Regarding the bone union, the percentage of non-union was low, and in all cases, it was achieved after reintervention. A low rate of major complications was observed. Conclusions: The orthoplastic team is the key to successfully treating the high-energy traumatism of the distal tibia (with or without a middle third). The Ilizarov external fixator can be used as a definitive limb-salvage treatment (secondary to the standard primary methods of fixation) in combination with a flap to cover the defects because it does not damage the pedicle, and it helps stabilize the soft tissues and bones around the flap to lower the complications.

Prospective study on functional outcome of distal femur fracture treated by open reduction and internal fixation using distal femur locking plate in Tibebe Ghion Specialized Hospital, Bahirdar, North West Ethiopia

BackgroundDistal femur fractures account for 6% of femur fractures. The treatment of distal femur fractures is challenging. Historically, nonoperative management has been the mainstay of management, which has evolved to operative management. There is no single implant used for all types of distal femur fractures. The implant evolves with time. The introduction of a distal femur locking plate (DF LCP) has had a great impact on the treatment. In developing countries like Ethiopia, there is scarcity of studies on functional outcome of operative treatment. So, this study aimed to assess the functional outcome of distal femur fractures treatment using distal femur locking plate.MethodsThis prospective cohort study was carried out among adult patients with distal femur fractures treated using distal femur locking plate at Tibebe Ghion Specialized Hospital from august 2022 to July 2023. A total of 60 patients with AO Type A and Type C fracture were included. All patients were followed for 6 months. Functional outcomes were assessed using Neer’s scoring system. Data was entered and analyzed using SPSS 27. Frequency, mean and cross tabulation were used to summarize descriptive statistics. Multinomial logistic regression was used to test the associations.ResultsIn our study out of 60 patients ,48.3% (29) had excellent functional outcomes, 30% (18) had good functional outcomes, 10% (6) had fair functional outcomes and 11.7% (7) had unsatisfactory functional outcomes according to Neer’s scoring system. Patients with closed distal femur fractures had 5 times higher probability of excellent functional outcome than those patients with open distal femur fractures (AOR (2.49(5.8 ,1.07)). Patients who had regular follow up had 7 times higher probability of excellent functional outcome than those who had no regular follow up (AOR 7.16(1.11,46.22)). The average union period was 4.63 months, with only 2 patients experiencing delayed union.ConclusionClosed fracture and regular follow up were determining factors for better functional outcomes. Closed fractures preserve the biological environment, which facilitates early fracture healing. The regular follow up helped patients to assess their rehabilitation status and pick any complication early.

Identifying Improvements in Treating Extremity Musculoskeletal Injuries During Prolonged Care.

In prolonged care scenarios, where medical evacuations are significantly delayed, the treatment and transport of casualties with extremity musculoskeletal injuries will drain combat units' human resources. Developing enhanced splinting techniques to restore casualty mobility and function can alleviate this drain. To guide this development, a panel of tactical combat and wilderness medicine experts was assembled to determine which extremity musculoskeletal injuries had the greatest impact on unit capabilities, and the materials available for splinting these injuries. Unstructured consultations with panel members yielded preliminary lists of injuries and materials. These lists were consolidated and redistributed to panel members for final evaluation where they ranked the injuries based on frequency and human resource cost and assessed the accessibility of materials. Responses for the final evaluation were statistically analyzed using Wilcoxon rank-sum tests and Placket Luce models. Aggregated responses indicated that panel members thought that knee and ankle ligamentous injuries and radial head fractures were the most frequently occurring injuries, although closed distal femoral fractures, below knee amputations, and open tibia fractures would require the most demand for injury care. Assessing the combined impact of frequency and human resource cost indicated that knee and ankle ligamentous injuries and closed tibia fractures had the greatest impact on unit readiness. Responses also indicated that a variety of materials would be available for applying or improvising splints. Although the combined impact of knee and ankle ligamentous injuries were ranked the highest, limitations in relative rankings and the existence of effective low-cost treatments for these injuries suggest that greater gains in unit effectiveness would come from focusing on developing solutions for fractures with higher human resource cost, such as leg and arm fractures. This information can be used to develop enhanced splints that can preserve unit readiness in the field.

Adverse Events and Efficacy of Acetazolamide in Meniere's Disease in a Vertigo Outpatient Clinic: A Retrospective Study.

Background Acetazolamide, a carbonic anhydrase inhibitor, is used in the treatment of several otolaryngological conditions, including Meniere's disease (MD). Despite its efficacy in reducing vertigo attacks, it is associated with a high rate of adverse events such as sensory disturbances, electrolyte imbalances, and liver dysfunction. The primary objective of this study is to evaluate the efficacy of acetazolamide in reducing vertigo attacks in MD patients. The secondary objective is to determine the incidence and severity of adverse drug events associated with acetazolamide treatment in this patient population. Methodology The study subjects were 70 patients who visited the vertigo outpatient clinic of our department from March 2019 to July 2024 and were diagnosed with definite or probable MD. Results A total of 15 cases had a history of acetazolamide prescription, with doses ranging from 125 to 750 mg/day. In total, 12 (80%) patients had symptoms of numbness in hands, feet, or other parts of the body, which caused discontinuation of medication after the initial prescription in five cases. Hypokalemia with liver dysfunction and hypokalemia with an open fracture of the distal end of the right radius due to staggering were observed in one patient each. In both cases of hypokalemia, Chinese herbal medicines containing licorice were prescribed in combination. Overall, 11 (73%) cases had a decrease in vertigo attacks. Hearing thresholds did not recover significantly after the prescription. Conclusions Although acetazolamide is effective in preventing vertigo attacks of MD, the rate of adverse events is high. Detailed instructions, careful dosage adjustment, periodic assessment of symptoms, and blood examinations for electrolyte and liver function are required.

A Short-Term Study of 18 Cases of Distal Femur Fractures Managed By Locking Compression Plate [Lcp] Using A Less Invasive Skeletal Stabilisation System [LISS

Distal femur fractures have traditionally been the most challenging to treat. Restoring full motion and function to the knee may be challenging due to these fractures' proximity to the knee joint. Regardless of the treatment method, comminution, damage of soft tissue, fracture extension into the knee joint, and related injury to the quadriceps mechanism frequently concludes in suboptimal outcomes. The early surgical fixation notion, increased implant availability, early postoperative knee joint immobilization, and a better understanding of damage patterns have all significantly improved the patient's functional result. Our study focuses on distal femur fractures managed by LCP [locking compression plate] using a less invasive skeletal stabilization system [LISS]. This is a retrospective research of 18 cases of distal femur fractures in adults who had LCP treatment with the LISS. The operation at Saveetha Medical College and Hospital in Chennai runs from January 2021 to January 2022. All types of intercondylar and supracondylar fractures are included. Children's fractures and pathological fractures were not included. Age distribution, side of injury, sex distribution, anatomy of injury, mechanism of injury, damage grading, subtype of fracture, concomitant injuries, and open fractures were the parameters used to assess the cases. AP and lateral views of the X-ray were taken. A thorough preoperative workup was completed. Every case was scheduled for surgery as soon as feasible. External fixators were used in the initial treatment of complicated cases. Patients underwent locking compression plate (LCP) fixation with the LISS. Radiological examination immediately following surgery, four weeks, six weeks, eight weeks, twelve weeks, four months, and every six months for a maximum of one year.The age range of the patients was 21 to 70 years, with a mean age of 30 years. A maximum incidence of fractures was noted in individuals aged 40 to 60. Males accounted for the majority of the 18 cases, with a female-to-male ratio of 3:5. Our series was predominantly right-sided. The most frequent cause of injury has been traffic accidents. Throughout the research period, no patients were lost to follow-up. Of the eighteen cases, the majority involved distal femur fractures, with intercondylar extension accounting for a higher number of cases, and isolated supracondylar fractures following. A head injury was present in one case, and acetabular fracture in another, a Boxer’s fracturein a third case, and 2 open fractures (1 compound grade III A, the other compound grade II). The fractures took an average of 13.3 weeks to heal. It required an average of 15.3 weeks longer in cases of compound fractures. Less than six degrees of malalignment (varus, valgus) were present. Every patient exhibited optimal articular alignment.Excellent outcomes were obtained with the LISS, which combines appropriate physiotherapy with an LCP (angle stable build). In principle, an LCP implant is the best option for fractured and osteoporotic bones. In summary, the use of LCPs in the LISS appears to yield superior outcomes when managing distal femur fractures.

Can limb length discrepancies be corrected with the Masquelet technique? A technical trick

Masquelet technique is a well-established procedure for reconstruction of bone defects secondary to such causes as infections, non-unions, tumors or open fractures with bone loss. The management of limb length discrepancies following bone defects has been well established using bone transport and remains the preferred choice amongst reconstruction surgeons. One of the criticisms of the Masquelet technique has been its limitation to address limb length discrepancies. We describe a technique for the correction of limb length discrepancies using the Masquelet technique.

Outcome Comparison of Multidirectional Locked Nailing and Plating for Distal Tibial Fractures: A Comparative Analytical Study

Introduction: This comparative analytical study explores the functional outcomes of treating distal tibial fractures using multidirectional locked nailing and plating. Distal tibia fractures, resulting from high-energy trauma, pose challenges due to soft tissue damage, infection risks, and potential unfavorable outcomes. Our study seeks to evaluate and contrast the functional results of treating distal tibial fractures using multidirectional locked nailing versus plating techniques. Materials and Methods: Conducted at Saveetha Medical College and Hospital from August 2022 to October 2023, the study involved 20 cases meeting specific criteria. Adult patients (18-70 years) with closed fractures and grade I compound fractures of distal tibia (AO type 43-A1, 43-A2, and 43-A3) were included. The cases were evenly divided between multidirectional locked nailing and plating groups. Subsequent evaluations, comprising both radiographic and clinical analyses, were performed at 6, 12, and 24-week intervals. Results: The study encompassed various parameters, including age distribution, causes of fractures, weight-bearing protocols, and joint movements. Multidirectional locked nailing demonstrated a shorter fracture union time, promoting earlier weight-bearing and functional exercises. Ankle and knee scores in this group indicated successful joint function restoration but with a higher malunion rate. Plating exhibited a lower malunion rate but a prolonged time to union. Complications, including superficial infections and wound dehiscence, were observed, emphasizing the importance of postoperative monitoring. Despite challenges, the plate group achieved satisfactory functional outcomes, highlighting fair to good ankle scores and full knee movement in all cases. Conclusion: In conclusion, the study underscores the distinctive advantages and considerations of each treatment approach. Multidirectional locked nailing facilitates faster union and joint function restoration but carries a higher malunion risk. Plating, with a lower malunion rate, requires meticulous postoperative care. The choice between the two methods should be individualized, considering patient-specific factors, fracture characteristics, and the surgeon's expertise. This research contributes valuable insights for informed decision-making in distal tibia fracture treatment.

Early experience using vacuum-assisted closure for managing soft tissue injuries in open type IIIB tibial fractures, a non-randomised controlled trial from a North African level one trauma centre

Purpose: The primary objective was to investigate our early results of using vacuum-assisted closure (VAC) for wound management in patients with open IIIB tibial fractures and compare the results with a group subjected to conventional daily dressing. Methods: A prospective non-randomised clinical trial (NRCT) with a parallel design and allocation ratio of 1:1 was conducted after obtaining ethical committee approval. Forty skeletally mature patients with unilateral type IIIB open tibia fractures were included over two years, starting from April 2019. In group A, patients were treated with VAC, which was changed every four days if needed, and in group B, patients had daily conventional dressings. Results: Both groups had no differences in the basic demographic, comorbidities, injury mechanism, and associated injuries. The need for secondary debridement surgeries was significantly lower in Group A than in Group B, 1 ± 0.50 versus 2.50 ± 0.85, respectively ( P &lt; 0.001). The time till definitive coverage was significantly lower in Group A than in Group B, 12.22 ± 2.90 versus 23.56 ± 8.68 (days); P &lt; 0.001. All coverage procedures succeeded in Group A, while four (20%) failed in Group B, P = 0.04. Infection was higher in Group B, with six (30%) patients compared to one (5%) in Group A, P = 0.01. Conclusion: Reports on VAC's role in managing severe open fracture wounds are rare in our area, and the initial results we obtained are encouraging, with lower infection rates and less cumbersome reconstruction procedures; however, further evaluation of the procedure's cost-effectiveness is mandatory.