Open Segmental Fracture Research Articles

Irreducible Tibial Pilon Fracture Treated with Single-Stage Closed Ilizarov Fixation and Gradual Correction: A Case Report.

A young polytrauma victim of a road traffic accident was diagnosed with comminuted articular fracture of the left distal tibial pilon and open segmental fracture of the fibula. The comminuted distal tibial metaphysis was translocated into the interosseous space and, hence, was irreducible. He underwent single-stage closed Ilizarov device stabilization and gradual postoperative closed reduction to obtain good functional outcome at 9 months. The lung and scapular injuries were treated conservatively. Acute complex irreducible tibial pilon fracture can be treated according to principles of deformity correction with the Ilizarov device.

Treatment of the Low Extremity Severe Mechanical Injury with Uncompensated Ischemia (Case Report)

Relevance. Discussion of the criteria for decision making “amputation vs. preservation”, when viability of the extremity is uncertain, has been continuing. The case description. The lower extremity of a serviceman was injured by a caterpillar tractor. The severity of the damage was determined by the following conditions: open segmental fracture of the femoral diaphysis, 5 cm traction-compression damage of the popliteal artery, acute thrombosis of the popliteal and tibial arteries, sciatic nerve damage, circular detachment of the thigh skin, acute hemorrhage, II degree shock, and uncompensated lower extremity ischemia throughout 24 hours. The MESS score of the injured extremity was 8 indicating that an amputation would have been considered. Nevertheless, we choose the organ preservation solution with the revascularization of the injured limb segment. A multi-stage treatment was carried out including stabilization of bone fragments, primary reconstruction of the popliteal artery to restore the arterial blood flow in the injured extremity, reperfusion injury and myoglobinuria elimination, intensive kidney protection therapy, infection management, skin defects replacement, orthopedic surgery. As a result of the treatment, the injured limb was saved. The femur fracture healed allowing the patient to walk without assistance. Conclusion. The use of the programmed surgical treatment for severe mechanical injury of the lower extremity, an individual multi disciplinary approach, assessing the severity of systemic disorders, and timely use of extracorporeal detoxification made it possible to avoid amputation, perform organ preservation surgery, and create favorable conditions for restoring the supporting function of the lower extremity.

English

INTRODUCTION: Tibia is most frequent site of an open fracture, with incidence ranging from 49.4% to 63.2%. India has the highest road accident rates in the world one of every forty two vehicle in country had met with an accident in 1986. A large proportion of vehicles involved were two wheelers. The lower Limbs are involved in 49.6 % of motor cycle accidents. By its very location the tibia is prone to frequent injuries. Furthermore, the blood supply of the tibia is more precarious, high-energy tibial fractures are associated with compartment syndrome or neural or vascular injuries(27,28). Open fractures have a higher infection rate than closed fractures(21,29) and the rate increases with the increasing severity of the soft tissue injury(25,26).The risk of delayed union and nonunion in closed, and open treatment is increased with comminution. Their treatment, prognosis, and outcome are mainly determined by the mechanism of injury, degree of comminution, soft tissue injury and displacement. AIM OF STUDY: Aim of our study is to highlight the important role of Ilizarov technique in the management of Grossly Comminuted Compound Tibial fracture. Aim of our study is to analyze the result of 20 cases of these complex grossly comminuted compound tibial fractures with Ilizarov technique. MATERIALS AND METHODS: Material consists of 20 cases of compound comminuted tibia using Ilizarov technique at Govt. Royapettah Hospital, Chennai between June 2005 to September 2007. The following types of cases were included 1. Compound diaphyseal fracture comminuted 2. Compound periarticular fracture. 3. Compound tibial plateau fracture 4. Compound metaphyseal fracture with shaft extension. 5. Compound segmental fracture. 6. Compound diaphyseal fracture with bone loss. Over the past 28 months we analyzed the treatment of 20 cases of compound tibial comminuted fracture using Ilizarov technique. METHODS: Frame Construction. Two half rings are selected that are 2-3 cm larger than the major diameter of the injured limb. The rings are positioned in the same plane and a bolt and nut anchor together at both ends of the half rings. Typically, a 4 ring assembly is required with 2 rings proximal and distal to fracture site. Two rings are used on large fragments. Ring & drop post used for smaller fragments. Two proximal & distal rings are connected via two rods of appropriate length . RESULTS: In our study, 20 cases were followed up until union and for further period till date. Patients were assessed for pain and functional limitations, and examined for angular and rotational mal-alignment and range of motion. Leg lengths were measured clinically. Pin tract infection occurred in 4 (20%) of cases. 2 resolved by systemic antibiotics for 5 days, in another one, soft tissue release around the offending wire was done and in one the wires had to be completely removed and reapplied. 2 (10%) patients had an angulation of 10° at the fracture site, and 4 (20%) had shortening between 1-2 cms of the fractured leg. Knee and ankle range of motion was satisfactory in almost all cases. There were no cases of osteomyelitis or neurologic or vascular complications among these patients. CONCLUSION: From our study of 20 cases of management of compound comminuted fracture tibia with Ilizarov technique, we conclude that Ilizarov technique has a definite role in the management of fracture tibia like 1. Open comminuted fracture: Open segmental fracture, Open fracture with bone loss, Open complex fracture. 2. It reduces hospital stay, 3. Full functional recovery, 4. Early weight bearing, 5. Gives definite union. To date we have not had any significant complication with Ilizarov method. Pain during treatment and acceptance of apparatus were two important subjective problems encountered in our experiences. The usage of Ilizarov apparatus provides definitive fixation for highenergy tibial fractures. Early weight bearing even in severely comminuted fractures is the key factor that separates it from other methods of fixation. It promotes early functional recovery, eliminating fracture disease. Dynamisation and correction of deformities in any plane is easily accomplished. Frame constructs could be modified to facilitate wound cover and access. Therefore it lends the much-needed flexibility in complex fractures

Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius

Extruded middle segment of radius with open segmental fracture both bone forearm and dislocation of ipsilateral elbow is a rare injury. A 12-year-old child presented to us within 4 hours following fall from tree. The child's mother was carrying a 12-cm-long extruded soiled segment of radius. The extruded bone was thoroughly washed. The medullary cavity was properly syringed with antiseptic solution. The bone was autoclaved and put in the muscle plane of the distal forearm after debridement of the wound. After 5 days, a 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment. Another 2.5-mm K-wire was passed in ulna. The limb was evaluated clinicoradiologically every 2 weeks. The wound was healed by primary intention. At 4 months, the reposed bone appeared less dense radiologically and K-wire seemed to be out of the bone. In the subsequent months, the roentgenograms show remodeling of the extruded fragment. After 20 weeks, the K-wires were removed (first ulnar and then radial). Complete union was achieved with full range of movement except loss of few degrees of extension of elbow and thumb. This case is reported to show a good outcome following successful incorporation of an extruded segment of radius in an open fracture.

Open segmental fractures of the tibia treated by external fixation

Open segmental fractures of the tibia are rare but severe injuries. In these fractures the wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture. The aim of our work was to present the results of treatment of patients with segmental open fractures of the tibia treated by external fixation. We analyzed treatment results of 21 patients with open segmental tibial fractures who were treated using the method of external fixation at the Clinical Center Nis from January 1, 1995 to July 31, 2010. The average age of the patients was 53 years; the youngest patient was 27 years and the oldest one 80 years. According to the Gustilo open fracture classification, there were 3 (14.3%) type 1, 6 (28.6%) type 11, 8 (38.1%) type IIIA, and 4 (19.0%) type IIIB. All the patients were treated by a unilateral type Mitković external fixator by Traffix Company. Union was attained in 16 (76.2%) fractures without severe complications (pseudoarthrosis, chronic osteitis and angular deformities of over 10 degrees). Among severe complications associated with open segmental tibial fractures, in two cases we registered septic pseudoarthrosis, in one aseptic pseudoarthrosis and in two large angular deformities of the tibia after union, with a valgus of over 10 degrees and extremity shortening of over 2 cm which required additional surgery. External fixation by the use of Mitković external fixator is one of the methods of choice in the treatment of open segmental tibial fractures, which incorporated with antibiotic therapy provides good biomehanical conditions for segmental fracture healing that enables good stability of the segmental tibial fracture and decreases the risk of deep infections.

Treatment of Open Segmental Fracture of the Tibia

Treatment of Open Segmental Fracture of the Tibia