Severe Soft Tissue Injury Research Articles

Mechanisms and Outcomes after Crush Injuries of the Foot

Crush injuries of the foot are poorly defined in the literature. Previous studies focus on the mechanism of injury or the environment in which they occur. Crush injuries can be associated with long-term sequelae including chronic pain and it has been suggested that seemingly less severe soft tissue injuries can carry significant morbidity equivalent to or worse than bony injuries. The aim of this multicentre study was to provide a contemporary overview of patients presenting with crush injuries to the foot.

Operative Fixation Versus Cast Immobilization: Tibial Shaft Fractures in Adolescents.

Tibial shaft fractures are common injuries in the adolescent age group. Potential complications from the injury or treatment include infection, implant migration, neurovascular injury, compartment syndrome, malunion, or nonunion. Published literature was reviewed to identify studies which describe the management options, complications, and outcome of tibial shaft fractures in adolescents. Acceptable alignment parameters for tibial shaft fractures have been defined. Operative indications include open fractures and other severe soft tissue injuries, vascular injury, compartment syndrome, ipsilateral femoral fractures, and polytrauma. Relative indications for operative treatment are patient/family preference or morbid obesity. Closed reduction and cast immobilization necessitates radiographic observation for loss of reduction over the first 3 weeks. Cast change/wedging or conversion to operative management may be required in 25% to 40%. Flexible nailing provides relative fracture stability while avoiding the proximal tibial physis, but the fracture will still benefit from postoperative immobilization. Rigid nailing provides greater fracture stability and allows early weight bearing but violates the proximal tibial physis. Plate and screw osteosynthesis provide stable anatomic reduction, but there are concerns with delayed union and wound complications related to the dissection. External fixation is an excellent strategy for tibia fractures associated with complex wounds but also requires observation for loss of reduction. The majority of adolescent tibia shaft fractures can be successfully managed with closed reduction and cast immobilization. Unstable fractures that have failed cast treatment should be treated operatively. Flexible intramedullary nailing, rigid intramedullary nailing, plate and screw osteosynthesis, and external fixation are acceptable treatment options that may be considered for an individual patient depending upon the clinical scenario.

Application of Intelligent Computer-Assisted Taylor 3D External Fixation in the Treatment of Tibiofibular Fracture: Retrospective Case Study.

BackgroundWith the development of modern society, severe and complex tibial fractures caused by high-energy injuries such as traffic accidents have gradually increased. At present, the commonly used methods for the treatment of tibial fractures include plate fixation, intramedullary nail fixation, and external fixation. Most of these fractures are open wounds with severe soft tissue injury and wound contamination, and some involve bone defects, which makes internal fixation treatment difficult.ObjectiveThis study aims to explore the use of intelligent computer-assisted Taylor 3D external fixation for the treatment of tibiofibular fractures.MethodsIn total, 70 patients were included and divided into the Taylor 3D external fixation (TSF) group (28 patients with severe tibial fractures treated with TSF) and the internal fixation group (42 patients with complicated tibiofibular fractures treated by internal fixation). After the treatment, the follow-up evaluation of TSF for the treatment of tibiofibular fractures noted the incidence of complications, as well as the efficacy and occurrence of internal fixation for the treatment of tibial fractures in our hospital.ResultsThe results showed that TSF was superior to orthopedics in the treatment of tibiofibular fractures in terms of efficacy and complications.ConclusionsTSF for the treatment of tibiofibular fractures is more effective than internal fixation and the incidence of complications is low. This is a new technology for the treatment of tibiofibular fractures that is worthy of clinical promotion.

Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions.

ObjectivesRadiation-induced soft-tissue injuries (STIs) in mandibular osteoradionecrosis (ORN) are not well studied regarding their correlations with nearby bone lesions. The aim of this study is to investigate the severity of radiation-induced STIs in advanced mandibular ORN and its relationship with hard-tissue damage and postoperative outcomes.MethodsA retrospective study was performed in our institution from January 2017 to December 2019. Aside from demographic factors, the associations between the triad ORN variables (irradiation doses, ORN stages, ORN sizes) and radiation-related STI factors, vascular characteristics, and postoperative functional recovery were assessed. In addition, the severity of STI was also compared with treatment outcomes. Such correlations were established via both univariate and multivariable analyses.ResultsA total number of 47 patients were included. The median follow-up reached 27 months. Nasopharyngeal cancer was the histology type among most patients (n = 21, 44.7%). The median irradiation doses reached 62 Gy (range, 40–110 Gy). For STI, the symptom scoring equaled an average of 5.4 (range from 1 to 12), indicative of the severity of STI problems. During preoperative MRI examinations, signs of hypertrophy or edema (n = 41, 87.2%) were frequently discerned. Most patients (n = 23, 48.9%) also had extensive muscular fibrosis and infection, which required further debridement and scar release. Surprisingly, most STI factors, except cervical fibrosis (p = 0.02), were not in parallel with the ORN levels. Even the intraoperative soft-tissue defect changes could not be extrapolated by the extent of ORN damage (p = 0.096). Regarding the outcomes, a low recurrence rate (n = 3, 6.9%) was reported. In terms of soft tissue-related factors, we found a strong correlation (p = 0.004) between symptom scores and recurrence. In addition, when taking trismus into consideration, both improvements in mouth-opening distance (p < 0.001) and facial contour changes (p = 0.004) were adversely affected. Correlations were also observed between the intraoperative soft-tissue defect changes and complications (p = 0.024), indicative of the importance of STI evaluation and management.ConclusionsThe coexistence of hard- and soft-tissue damage in radiation-induced advanced mandibular ORN patients reminds surgeons of the significance in assessing both aspects. It is necessary to take the same active measures to evaluate and repair both severe STIs and ORN bone lesions.

Treatment of fracture distal third tibia by plating versus nailing: Comparative study

BackgroundIt is often difficult to choose the optimal method for treating the fractures of the lower third tibia due to its closeness to ankle joint, poor blood supply, decrease of the muscles covering the anterior, complications, such as delayed union, nonunion, wound dehiscence, which are usually associated with comminution, severe soft tissue injury. Therefore, the management of the fracture of lower third tibia remains a great challenge to surgeons.Patients and methodsBetween January 2017-January 2020, 96 participants with distal tibial fractures were treated using either MIPO technique or Expert intramedullary nail technique, in a prospective study conducted in Zagazig University Hospitals. 48 participants treated by MIPO technique, 48 participants treated by Expert intramedullary nailing.ResultsThe average age was 45 years, the mean age in gathering A was 46.58±14.9, and in gathering B was 44.83±13.73. The data of Participants were collected in terms of the name, age, sex, occupation, address, special habits, mechanism of injury, associated injury, history of comorbidities e.g. diabetes, hypertension, and peripheral vascular disease. ConclusionDistal tibial fractures often present a challenge to the orthopaedic surgeon. The treatment of this type of fracture is of current research interest, since there is no universally agreed treatment method. The choice of treatment must take into account not only the stabilization of the fracture, but also the management of the soft tissue injury which is a frequent cause of subsequent complications.

Shewanella algae and Morganella morganii Coinfection in Cobra-Bite Wounds: A Genomic Analysis.

Naja atra bites cause severe soft tissue injury and are prone to wound infections. The pathogens of Naja atra bite-wound infections are highly variable in different geographical regions. Here, we report the first coinfection with Shewanella algae and Morganella morganii from a Naja atra bite wound with resistome analysis using whole genome sequencing.

Outcomes of severe lower limb injury with Mangled Extremity Severity Score ≥ 7

Complex fractures of the femur and tibia with associated severe soft tissue injury are often devastating for the individual. The aim of this study was to describe the two-year patient-reported outcomes of patients in a civilian population who sustained a complex fracture of the femur or tibia with a Mangled Extremity Severity Score (MESS) of ≥ 7, whereby the score ranges from 2 (lowest severity) to 11 (highest severity). Patients aged ≥ 16 years with a fractured femur or tibia and a MESS of ≥ 7 were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (January 2007 to December 2018). Cases were grouped into surgical amputation or limb salvage. Descriptive analysis were used to examine return to work rates, three-level EuroQol five-dimension questionnaire (EQ-5D-3L), and Glasgow Outcome Scale-Extended (GOS-E) outcomes at 12 and 24 months post-injury. In all, 111 patients were included: 90 (81%) patients who underwent salvage and 21 (19%) patients with surgical amputation. The mean age of patients was 45.8 years (SD 15.8), 93 (84%) were male, 37 (33%) were involved in motor vehicle collisions, and the mean MESS score was 8.2 (SD 1.4). Two-year outcomes in the cohort were poor: six (7%) patients achieved a GOS-E good recovery, the mean EQ-5D-3L summary score was 0.52 (SD 0.27), and 17 (20%) patients had returned to work. A small proportion of patients with severe lower limb injury (MESS ≥ 7) achieved a good level of function 24 months post-injury. Further follow-up is needed to better understand the long-term trajectory of these patients, including delayed amputation, hospital readmissions, and healthcare utilization. Cite this article: Bone Joint J2021;103-B(4):769-774.

External fixation of olecranon fracture associated with soft tissue damage: a case report

: Olecranon fracture has been operated widely with tension band wiring introduced by Weber and Vasey, or, in case of comminution, with plating. Soft tissue injury around elbow, however, contraindicates the open reduction and internal fixation of olecranon. This study discusses the efficacy of external fixation in case of olecranon fracture associated with soft tissue injury, which has not been well studied yet. Twenty patients (20 elbows) with closed or open olecranon fracture (AO/ASIF classification IC 2–3 & IO 2) had been treated with olecranon external fixator, and then they were investigated with follow-up period of at least 2 years. Operation time and wound healing problems were recorded, and then final range of motion of the elbow and functional outcome (MEPI) were assessed at the time of the latest follow-up. In this study, the average operation time was 21.5±5.8 min. There was no deep infection, but only one mild stiffness happened. There was no nonunion. At the time of the latest follow-up, flexion arc of the elbow was 110±5.0 degree, and the average MEPI was 90. This result suggests that severe soft tissue injury associated olecranon fracture which is usually impossible to apply ORIF and that produces a lot of intractable problems can be treated successfully with olecranon external fixator.

Clinical Faceoff: The Complex Tibial Plafond Fracture: ORIF or Circular External Fixation?

Clinical Faceoff: The Complex Tibial Plafond Fracture: ORIF or Circular External Fixation?

Primary union with external fix in open bothbone leg fracture as definative management

These days RTA and violence are on the rise and accounting for more cases of trauma in which bony injuries are common .Fracture of tibial shaft is due to its subcutaneous location is very often involved in these kind of injuries.this study was done to evaluate the effectiveness of external fixator as primary and definitive treatment for open tibia fractures, fractures with severe soft tissues injuries, threatened compartment syndrome, and in multiply injured patients [1]. Intramedullary nailing is considered the method of choice for treatment of closed diaphyseal fractures of long bones. However, there is controversy in the literature regarding the best way of managing open type II and type III fractures, tibial shaft fractures with severe soft tissue injuries or compartment syndrome, multiply injured patients. Material and Methods: A total of 16 patients who satisfied our inclusion and exclusion criteria were taken and were treated with AO external fixator as primary or secondary to failed Intramedullary nailing . patients were assessed radiologically and clinically. Results: as per clinical parameters of Karlstrom and Olerud 37% patients had excellent outcome 31% had good outcome 18% had fair outcome and 12% had poor outcome. Conclusion: Meticulously primary wound debridement at earliest is an absolute. Which augments prognosis and prevents complication. External fixator is now accepted, reliable and convenient method to manage open Long Bones fracture.

A comparative study based on surgical and functional outcome of proximal tibia fractures between unicondylar and bicondylar fractures

Background: Tibia plateau fractures constitute 1%of all fractures. Bicondylar fractures account for 10-30%, whereas isolated medial and lateral condyle fractures constitute the remaining injuries. Although only 3% of these fractures are open injuries, many of them have closed degloving, deep abrasions or severe soft tissue injuries which require careful consideration in deciding the timing and the nature of surgery. Proximal tibia fractures may be difficult to treat even in experienced hands due to intraarticular extension, comminution, cartilage damage and soft tissue injuries of the cruciate ligaments and menisci. Aim: To compare the functional and surgical outcomes of operative treatment of unicondylar and bicondylar fractures. Materials and Methods: It was a prospective and comparative study of Surgical and functional outcome of proximal tibial fractures in the department of orthopaedics from July 2019 to December 2019. Clearance was obtained from the hospital ethical committee. Fifty patients were taken into consideration for the study. All patients are selected on the basis of history, clinical examination and radiography. The Schatzker’s classification was used to classify these fractures. The patients were followed up for an average period of 6 to 12 months. The patients were divided into two groups. Twenty-five patients in the unicondylar fracture group 1and 25 patients in the bicondylar fracture group 2. Results: The mean age of group 1 patients was 45.7210.85 years, and that of group 2 patients was 46.408.602 years (p>0.05). In group 1 there were 18 (72%) males and 7 (28%) females, in group 2 there were 21 (84%) males and 4 (16%) females. In group 1, the mean union time was 3.04 0.351 and in group 2 was 3.1 0.433(p>0.05). In group 1, the mean follow-up time was 12.81 2.09 and in group 2 was 13.04 2.28 (p>0.05). The mean functional score of group 1 was 91.212.27, and in group 2, it was 8718.2 (p>0.050). In group1 mean WOMAC score was

Evaluation of results of surgical management of lateral tibial condyle fractures using locking compression plate

Introduction: Tibial plateau fractures are the common injuries that may be associated with poor outcomes and a high rate of complications. The problem rise significantly in high energy trauma and severe soft tissue injuries. Locked compression plating system has clear biomechanical advantages and avoids iatrogenic tissue damage when compared with conventional plating. The purpose of surgical management is to restore and preserve normal knee function. It can be accomplished by anatomical restoration of articular surfaces, maintaining mechanical axis, restoring ligamentous stability and preserving a functional pain free range of motion of knee. Materials and Methods: This is a prospective study of 36 patients with tibial plateau (Schatzker type I, II and III) fractures fixed with lateral locking compression plate over lateral surface of tibia and followed for a minimum period of 6 months and evaluated by using Rasmussen knee score system. Results: All patients were followed properly but two patients were lost to follow up so only remaining 34 patients were finally evaluated for functional outcome. Mean age of patient was 38.8 years with range of 19 to 70 years. All fractures united by average of 17.5 weeks (range 14-25 weeks) with delayed union observed in 6 cases. Three patients had wound dehisence, three varus deformity, one deep vein thrombosis, four arthritis and five cases of each knee joint pain & stiffness. According to Rasmussen's scoring system, 52.94% patients had excellent results, 32.35% patients had good, 8.22% fair and 5.88% poor result. Conclusions: Locking plates are good option for lateral tibial condyle fractures with minimum complications. Anatomical reduction can be easily maintained with locking plates, which also helps in early mobilization and hence obtaining good functional outcome in tibial condylar fractures. Keywords: Tibial plateau fractures, Schatzker (type I, II and III) classification, Locking compression plate, Rasmussen knee score

Generation of Open Metatarsal Fracture in Rats: A Model for Secondary Fracture Healing

A fracture model in rats for the study of secondary bone healing was described. Standard open midshaft transverse metatarsal fracture was produced with bone cutting forceps in 28 rats. The commonly open and close fracture models utilized for bone and mineral researches are associated with varying degree of complications ranging from a high degree of fracture comminution to severe associated soft tissue injury which interferes with the healing process. We hypothesized that fracture model in rat third metatarsal bone could be associated with low -post-surgical complications and could be a reproducible model. To test this, open mid-shaft transverse fractures were created on the metatarsals of 28 rats. The objectives of the study were to evaluate the fracture complications, to determine the nature of fracture produced, evaluate the fracture consolidation during healing periods, and to assess the histological and radiographic healing of the fracture. The fracture produced in the mid metatarsal shaft of all rats was 100% transverse, 73% located at the midshaft. Minimal fracture angulations were recorded (0.48 ± 0.09o; 0.78 ± 0.17o) for anterior-posterior and lateral views respectively. Minimal soft tissue injury was recorded immediately post-surgery, but no infection and the delayed union was observed. Varying degrees of weight-bearing lameness was also recorded but seized at day six onward post-operative. Callus index observed was peaked at week 2 and 3 (2.02 ± 0.1, 1.99 ± 0.13) respectively but declined to 1.10 ± 0.04 at week 7 during the consolidation period. The fracture line disappeared completely at week 7. The histological and radiographic healing scores were (3.5 ± 0.13 and 3.75 ± 0.25) respectively (out of the maximum healing score of 4) at week 7 post-operative. There was a positive correlation between the histological and radiographic healing scores. The metatarsal fracture model is considered to be a suitable model for in vivo study of secondary fracture healing. Doi: 10.28991/SciMedJ-2020-0204-2 Full Text: PDF

Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report

BackgroundSevere varus deformity and soft tissue injury caused by a burn around a complex knee dislocation is a rare injury. Soft tissue reconstruction and deformity correction with circular hexapod external fixation of the knee and hinged total knee arthroplasty (TKA) are challenging and can lead to major complications if not performed appropriately. We present a case in which a combination of soft tissue reconstruction, circular hexapod external fixation, and TKA was used treat severe knee dislocation due to burn scarring.Case presentationWe report the case of a 58-year-old woman who presented for knee surgery with soft tissue reconstruction, deformity correction with circular hexapod external fixation, and hinged TKA for a severe complex deformity and soft tissue injury caused by a burn injury at 6 months of age. The left leg was shorter by 35 mm in terms of functional leg length discrepancy. She walked with a limp, with a marked varus deformity of the left knee during the stance phase of walking. After a 3-stage repair, the patient was able to walk without assistance, confirming improvement of mobility.ConclusionThe treatment method was an effective use of a combination of soft tissue reconstruction, circular hexapod external fixation, and rehearsal surgery using a 3D printed bone model of the modular rotating hinge component of TKA, which was successfully used to treat a severe knee dislocation due to burn scarring. This staged surgery maintained the leg length and ultimately achieved a satisfactory alignment.

Vetrivel trauma score – An evidence-based scoring system to predict limb salvage and outcomes in gustilo anderson grade III B and C compound fractures of lower extremities

Background: Open fractures with severe soft-tissue injuries are clinically challenging to treat. While several scoring systems are available to grade these clinical conditions, the Gustilo Anderson grading system is most commonly used. This grading system neither offers any clue regarding salvaging open fractures of Grade III B and above, nor does it help the surgeon to assess the outcomes in such injuries. Hence, a new system of grading was assessed to address this deficiency. Materials and Methods: Five hundred and twelve open fracture cases were analyzed for this study. Two hundred and twenty-seven patients sustained Grade III injuries according to the Gustilo Anderson classification; Of these, 175 patients had Grade III A open fractures and 52 patients were of Grade III B and above. The 52 patients with open fractures of Grade III B and above were scored using mangled extremity severity score (MESS), Ganga score, and our novel scoring system. The accuracy in deciding amputation and predict outcomes were measured. Results: The scores assessed by the new scoring system were compared with MESS, Gustilo grading, and Ganga score system. Binary logistic regression analysis indicated our scoring system to be more accurate compared to all other scoring systems (P = 0.02). A receiver operating characteristic curve was plotted to compare all other scoring systems. The area under the curve (0.996 ± 0.003) for our scoring system was significantly higher with the less standard error of the mean than other scoring systems compared. Conclusions: Our new scoring system was more accurate in predicting limb salvage and outcomes compared to the existing scoring systems for open fractures of Grade III B and above.

Fabrication and in vitro evaluation of 3D composite scaffold based on collagen/hyaluronic acid sponge and electrospun polycaprolactone nanofibers for peripheral nerve regeneration.

Replacement of peripheral nerve autografts with tissue engineered nerve grafts will potentially resolve the lack of nerve tissue especially in patients with severe concomitant soft tissue injuries. This study attempted to fabricate a tissue engineered nerve graft composed of electrospun PCL conduit filled with collagen-hyaluronic acid (COL-HA) sponge with different COL-HA weight ratios including 100:0, 98:2, 95:5 and 90:10. The effect of HA addition on the sponge porosity, mechanical properties, water absorption and degradation rate was assessed. A good cohesion between the electrospun PCL nanofibers and COL-HA sponges were seen in all sponges with different HA contents. Mechanical properties of PCL nanofibrous layer were similar to the rat sciatic nerve; the ultimate tensile strength was 2.23 ± 0.35 MPa at the elongation of 35%. Additionally, Schwann cell proliferation and morphology on three dimensional (3D) composite scaffold were evaluated by using MTT and SEM assays, respectively. Rising the HA content resulted in higher water absorption as well as greater pore size and porosity, while a decrease in Schwann cell proliferation compared to pure collagen sponge, although reduction in cell proliferation was not statistically significant. The lower Schwann cell proliferation on the COL-HA was attributed to the greater degradation rate and pore size of the COL-HA sponges. Also, dorsal root ganglion assay showed that the engineered 3D construct significantly increases axon growth. Taken together, these results suggest that the fabricated 3D composite scaffold provide a permissive environment for Schwann cells proliferation and maturation and can encourage axon growth.

Biomechanical analysis of simultaneous distal and proximal radio-ulnar joint instability

BackgroundSimultaneous dislocation of the proximal and distal radio-ulnar joints without bony injuries has been reported, but the mechanism remains unclear. We investigated concurrent proximal and distal radio-ulnar joint instability after sequential sectioning of the annular ligament, triangular fibrocartilage complex, and quadrate ligament. MethodsWe performed this biomechanical study with six fresh-frozen cadaveric upper extremities. Proximal and distal radio-ulnar joint displacement was measured using an electromagnetic tracking device during passive mobility testing with anterior, lateral, and posterior loads on the radial head with pronation, supination, and neutral rotation. Measurements were statistically analyzed using the generalized linear mixed model. FindingsProximal radio-ulnar joint instability was significantly greater after sectioning of the annular (lateral: 1.4%, P < .05; posterior: 0.7%, P < .05) and quadrate (lateral: 43.7%, P < .05; posterior: 29.5%, P < .05) ligament. Distal radio-ulnar joint instability was significantly greater in every sequential stage (final stage: anterior: 24.1%, P < .05; lateral 21.0%, P < .05; posterior: 31.3%, P < .05). Finally, significant simultaneous instability of the joints was observed after sectioning of the annular ligament, triangular fibrocartilage complex, and quadrate ligament, and neutral rotation potentially induced gross instability. InterpretationOur ligament injury model induced simultaneous proximal and distal radio-ulnar joint instability without bony or interosseous membrane injury, probably induced by severe soft tissue injury. Proximal radio-ulnar joint instability may influence distal radio-ulnar joint instability from pivoting of the interosseous membrane. Our findings will help surgeons evaluate the magnitude of soft tissue injury and plan surgery for patients with simultaneous proximal and distal radio-ulnar joint instability.

A Modified 2-Stage Treatment for AO/OTA 43-C1 Pilon Fractures Accompanied by Distal Fibular and Posterior Lip of the Distal Tibia Fracture

The management of pilon fractures remains challenging owing to the high-energy axial loading mechanism that produces comminution of the articular surface, displacement of tibia metaphysis, and severe soft tissue injury. How to preserve the vitality of soft tissue and achieve anatomic reduction has become a timely issue. We report and evaluate the effect of a modified staging treatment for AO Foundation/Orthopaedic Trauma Association (AO/OTA) 43C1 pilon fracture accompanied by distal fibular and posterior lip of the distal tibia fracture. We performed a modified 2-stage treatment of type C1 pilon fracture with distal fibular and posterior malleolar fractures. In the first stage, the posterolateral incision was used for simultaneous reduction of fibula and posterior malleolus, and the tibia was fixed with an external fixator. In the second stage, the external fixator was removed, and the medial malleolus and tibia were fixed after the edema of soft tissue had subsided. The following data were collected: Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Short Form 36 (SF-36) score, Burwell-Charnley fracture reduction score, and postoperative complications. Twenty-seven patients were monitored for an average of 31.70 ± 7.38 months. The Burwell-Charnley fracture reduction scores had anatomic and fair ratings of 92.59%. SF-36 physical component score was 42.94 ± 12.47 and mental component score was 48.73 ± 9.79. Score data from the multiple scales of FAOS included pain, 88.79 ± 8.59; activities of daily living, 91.89 ± 7.50; quality of life, 90.26 ± 10.52; sports, 87.93 ± 11.64; and symptoms, 85.32 ± 8.65. The AOFAS ankle-hindfoot scores were 87.30 ± 13.45. Complications were reported in 5 patients (18.52%). Our study provides a good alternative to the existing protocol for type C1 pilon fractures with distal fibular and posterior lip of the distal tibia fracture and effectively reduces soft tissue complications.

Management of the Floating Knee: Ipsilateral Fractures of the Femur and Tibia.

The "floating knee" is defined as fractures of the ipsilateral femur and tibia, which consists of a spectrum of injury, and may be in isolation or part of multiple system trauma for a given patient. A floating knee may compromise limb viability due to severe soft-tissue and vascular injury. Expeditious fracture reduction and patient resuscitation are crucial, while type and timing of provisional and definitive management is guided by the extent of injury to the involved extremity and associated systemic injuries. Numerous surgical techniques are available to treat the floating knee, including external fixation and internal fixation with plates or intramedullary nails. Fracture complexity and severity of soft-tissue injury present challenges, with articular injuries potentially more debilitating in the long term. Complications such as infection, deep vein thrombosis, knee stiffness, nonunion, malunion, and posttraumatic arthrosis after these injuries should be considered.

Radiological and functional comparison of conservative and percutaneous methods in calcaneus fractures with severe soft tissue injury and edema

There are different methods to treat calcaneus fractures. Since it is a weak area especially in terms of soft tissue coverage, an appropriate treatment method should be selected for the patient. Our goal in this study is to compare closed reduction-plastering (CRP) and closed reduction-percutaneous fixation (CRPF) techniques radiologically and functionally in patients unable to have open reduction-internal fixation due to severe soft tissue injury and edema. A total of 116 patients who underwent CRP (65 patients) and CRPF (51 patients) techniques between January 2015 and December 2018 at our clinic were included in the study. These two groups were divided into two subgroups according to the Sanders classification. Patients were evaluated according to follow-up time and fracture type. They were also evaluated radiographically based on fracture healing time and Bohler and Gissane angle measurements before and after treatment, and functionally using the AOFAS, MFS, and NPRS scales. Both groups had a mean follow-up of 3 years. In the CRPF group, the Bohler and Gissane angles were found to be restored better than in the CRP group, although this was not statistically significant (p=0.421, p=0.554, p=0.751, p=0.698). In functional evaluations with the AOFAS and MFS scales, better scores were calculated in the CRPF group and a statistically significant difference was found (p=0.017, p=0.023). Also, better outcomes were found for Sanders type 2 fractures than type 3 fractures. In patients with severe soft tissue injury and edema, a better reduction of functional outcomes can be achieved with the CRPF technique compared to CRP. This technique is convenient, reliable, and cost-effective. With this technique, more improvement can be achieved in radiological measurements. Finally, the Sanders classification has prognostic significance.