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International Journal of Surgery Case... May 2024During femoral fracture osteosynthesis, the superficial femoral artery can be incarcerated in the cerclage wiring. We report a case that had an iatrogenic superficial...
INTRODUCTION AND IMPORTANCE
During femoral fracture osteosynthesis, the superficial femoral artery can be incarcerated in the cerclage wiring. We report a case that had an iatrogenic superficial femoral artery injury due to cerclage wiring during femoral osteosynthesis.
CASE PRESENTATION
I reported a 57-year-old patient presented with a fracture at the distal third of the left femur. He had undergone a femoral nailing and a cerclage wiring. Four hours postoperative, his left leg was colder, and his dorsalis pedis and posterior tibial pulse were absent. A CTA revealed his left superficial femoral artery entrapment by cerclage wire. After cerclage removal, the superficial femoral artery and vein had normal flow. The dorsalis pedis and posterior tibial pulse could be palpated. One day following, there was no compromising of blood flow, sensation, or motor-nerve function.
CLINICAL DISCUSSION
Cerclage wiring in the proximal half of the femur was less risk to the femoral artery than in the distal part. The SFA entrapment into a femoral cerclage wire requires an urgent diagnosis and treatment. A missed diagnosis could lead to necrosis of the lower extremity and even death.
CONCLUSION
Our case shows that the superficial femoral artery can be incarcerated in the cerclage wiring during osteosynthesis. Cerclage wiring in the proximal half of the femur was less risk to the femoral artery than in the distal part. We recommend using a suitable cerclage passer precautionary in any femur fracture, particularly in the distal third of the femur.
LEVEL OF EVIDENCE
A case report.
PubMed: 38759400
DOI: 10.1016/j.ijscr.2024.109765 -
Strategies in Trauma and Limb... 2024Tibial osteomyelitis can follow open fractures with bacteria colonising the wound and persisting through biofilm and sequestrum formation. The treatment is complex,...
INTRODUCTION
Tibial osteomyelitis can follow open fractures with bacteria colonising the wound and persisting through biofilm and sequestrum formation. The treatment is complex, requiring eradication through debridement before limb reconstruction, for which the Taylor spatial frame (TSF) is one option. This study evaluates patient outcomes after reconstruction and identifies factors associated with post-operative complications.
MATERIALS AND METHODS
Fifty-one cases of tibial osteomyelitis were treated by the Ilizarov technique from 2015 to 2021 at a major trauma centre. Bacterial samples and treatment factors were assessed. Patient outcomes were complication rates and time to bony union. Complications were expressed as odds-ratios (OR) with 95% confidence intervals. Linear regression was used to assess factors associated with time to union.
RESULTS
The mean follow-up was 24.1 months with the mean time to radiological union being 11 months. Post-operative complications were noted in 76.5% of patients with pin-site infections most common (52.9%), followed by fracture malunion (29.4%). Smoking was associated with increased fracture malunion (OR = 4.148, 95% confidence Interval [1.13-15.18], = 0.031). The time to union was positively associated with complications, age and time to full weight-bearing (FWB). All other measured factors were found not significant.
CONCLUSION
Tibial osteomyelitis is treated reliably by debridement and reconstruction using the Ilizarov technique using a TSF application. The most common complication was pin-site infection. Optimising patients through cessation of smoking and encouraging post-operative weight-bearing can reduce the complication rate and improve time to union.
CLINICAL SIGNIFICANCE
The Ilizarov technique using a TSF can treat significant deformities that result from the management of tibial osteomyelitis.
HOW TO CITE THIS ARTICLE
Geetala R, Zhang J, Maghsoudi D, . The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. Strategies Trauma Limb Reconstr 2024;19(1):32-35.
PubMed: 38752193
DOI: 10.5005/jp-journals-10080-1613 -
Strategies in Trauma and Limb... 2024This prospective study assessed the clinical and radiological outcomes of open tibia fractures treated with a dynamic external fixator.
AIM
This prospective study assessed the clinical and radiological outcomes of open tibia fractures treated with a dynamic external fixator.
MATERIALS AND METHODS
Twenty-five patients underwent surgical debridement and stabilisation with a dynamic external fixator between November 2016 and April 2022. Regular follow-up evaluated bone healing progression.
RESULTS
Favourable outcomes were demonstrated in 20 patients. However, there were three cases of non-union, two of which subsequently deformed, and two cases of pin site-related infection. There were no fracture site infections.
CONCLUSION
This study demonstrates the use of dynamic external fixation in the treatment of open tibia fractures. The low incidence of complications suggests its effectiveness and potential.
HOW TO CITE THIS ARTICLE
Bezerra BS, Araujo TA, Cardonia GG, . The Applicability of Dynamic External Fixator in a Prospective Evaluation of Open Tibial Fracture Treatment. Strategies Trauma Limb Reconstr 2024;19(1):36-39.
PubMed: 38752189
DOI: 10.5005/jp-journals-10080-1606 -
BMC Musculoskeletal Disorders May 2024The objective of this study was to evaluate and compare the effectiveness and clinical results of trifocal bone transport (TBT) and pentafocal bone transport (PBT) in... (Comparative Study)
Comparative Study
PURPOSE
The objective of this study was to evaluate and compare the effectiveness and clinical results of trifocal bone transport (TBT) and pentafocal bone transport (PBT) in treating distal tibial defects > 6 cm resulting from posttraumatic osteomyelitis, highlighting the potential advantages and challenges of each method.
METHODS
A retrospective assessment was conducted on an overall population of 46 eligible patients with distal tibial defects > 6 cm who received treatment between January 2015 and January 2019. Propensity score analysis was used to pair 10 patients who received TBT with 10 patients who received PBT. The outcomes assessed included demographic information, external fixation time (EFT), external fixation index (EFI), bone and functional outcomes assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated using the Paley classification.
RESULTS
The demographic and baseline data of the two groups were comparable. Following radical debridement, the average tibial defect was 7.02 ± 0.68 cm. The mean EFT was significantly shorter in the PBT group (130.9 ± 16.0 days) compared to the TBT group (297.3 ± 14.3 days). Similarly, the EFI was lower in the PBT group (20.67 ± 2.75 days/cm) than in the TBT group (35.86 ± 3.69 days/cm). Both groups exhibited satisfactory postoperative bone and functional results. Pin site infection was the most common complication and the rates were significantly different between the groups, with the PBT group demonstrating a higher incidence.
CONCLUSION
Both TBT and PBT effectively treat posttraumatic tibial defects greater than 6 cm, with PBT offering more efficient bone regeneration. However, PBT is associated with a higher rate of pin site infections, highlighting the importance of careful management in these complex procedures and emphasizing the need for expert surgical execution and tailored treatment approaches in orthopedic reconstructive surgery.
Topics: Humans; Osteomyelitis; Male; Female; Retrospective Studies; Adult; Middle Aged; Treatment Outcome; Debridement; Tibia; Tibial Fractures; Bone Transplantation; External Fixators
PubMed: 38750523
DOI: 10.1186/s12891-024-07507-w -
Scandinavian Journal of Trauma,... May 2024This research investigated surgical interventions for the treatment of extremity and pelvic fractures and aimed to provide an analysis of management challenges under...
BACKGROUND
This research investigated surgical interventions for the treatment of extremity and pelvic fractures and aimed to provide an analysis of management challenges under crisis conditions in a Level I Trauma Center after Türkiye's February 6, 2023, earthquakes.
METHODS
The study was a retrospective examination of the medical records of 243 fracture cases associated with the earthquakes. The age, gender, time of admission, types of extremity and pelvic fractures, anatomical localizations, and surgical treatment methods for fractures were recorded. The results of these parameters were evaluated in detail, together with the results of other surgical treatments performed in the hospital in the first week after the disaster, such as fasciotomy, amputation, and wound debridement.
RESULTS
Most of the 243 (119 males and 124 females) patients with extremity fractures and pelvic fractures receiving surgical treatment were adults (n = 182, 74.9%). The most common lower extremity fractures among all fracture cases were tibial shaft (30.8%) and femoral shaft (20.6%) fractures. A total of 33 patients had surgical procedures for the treatment of two or more significant bone fractures involving either the extremity or the pelvic ring. The analysis showed that the median age of patients who underwent surgery due to extremity and pelvic fractures was 36 years, with a range of 1 to 91 years, which was statistically increased compared to patients who received surgery for other musculoskeletal injuries such as fasciotomy, amputation and debridement (p < 0.001).
CONCLUSION
Fractures were one of the most common musculoskeletal injuries in the first days after earthquakes, and the management of fractures differs significantly from soft tissue injuries and amputation surgeries as they require implants, special instruments, and imaging devices. The delivery of healthcare is often critically impaired after a severe earthquake. Shortages of consumables such as orthopedic implants, power drills, fluoroscopy equipment, and the need for additional staff should be addressed immediately after the earthquake, ideally by the end of the first day.
Topics: Humans; Earthquakes; Male; Female; Retrospective Studies; Adult; Middle Aged; Fractures, Bone; Trauma Centers; Aged; Adolescent; Young Adult; Child; Aged, 80 and over; Pelvic Bones; Child, Preschool
PubMed: 38730466
DOI: 10.1186/s13049-024-01217-x -
JPRAS Open Jun 2024Congenital pseudoarthrosis of the tibia (CPT) is a rare pathological disease associated with neurofibromatosis type 1 (NF1). It presents with tibial bowing and can...
BACKGROUND
Congenital pseudoarthrosis of the tibia (CPT) is a rare pathological disease associated with neurofibromatosis type 1 (NF1). It presents with tibial bowing and can progress into a nonhealing fracture. Treatment options include conservative approaches such as serial bracing or various surgical options.Surgically, the aims are to achieve long-term bone union, prevent limb length discrepancies (LLDs), and avoid mechanical axis deviation, soft tissue lesions, nearby joint stiffness, and pathological fracture.The purpose of our study is to highlight our experience with both the conservative approach and the use of vascularized free fibula reconstruction of these deformities, including the challenges encountered with a long-term follow-up until skeletal maturity.
METHODS
We present a retrospective analysis of a total of nine (9) patients consisting of three (3) girls and six (6) boys. Six (6) children were treated with a vascularized fibula flap, and the other three (3) were treated conservatively. Outcomes measured included fractures, LLD, ankle valgus deformity, donor site morbidity, and number of surgical corrections.
RESULTS
All patients had flap survival. Three (3) of six children had a previous failed surgery with intramedullary nail and bone graft prior to performing a vascularized free fibula reconstruction. The follow-up period ranged from 8 months to 200 months. The complications included stress fractures (50%), LLD (66.6%), and ankle valgus (33.3%). During growth phases, these children required multiple corrective surgeries.
CONCLUSIONS
Fibula free flap is a good treatment option for CPT even in patients with prior surgical failures with variable results. - Level 4 - Case series Therapeutic Studies-Investigating the Results of Treatment.
PubMed: 38726048
DOI: 10.1016/j.jpra.2024.02.007 -
BMC Musculoskeletal Disorders May 2024External fixation is widely used in the treatment of traumatic fractures; however, orthopedic surgeons encounter challenges in deciding the optimal time for fixator...
BACKGROUND
External fixation is widely used in the treatment of traumatic fractures; however, orthopedic surgeons encounter challenges in deciding the optimal time for fixator removal. The axial load-share ratio (LS) of the fixator is a quantitative index to evaluate the stiffness of callus healing. This paper introduces an innovative method for measuring the LS and assesses the method's feasibility and efficacy. Based on a novel hexapod LS-measurement system, the proposed method is to improve the convenience and precision of measuring LS in vivo, hence facilitating the safe removal of external fixators.
METHODS
A novel hexapod system is introduced, including its composition, theoretical model, and method for LS measurement. We conducted a retrospective study on 82 patients with tibial fractures treated by the Taylor Spatial Frame in our hospital from September 2018 to June 2020, of which 35 took LS measurements with our novel method (Group I), and 47 were with the traditional method (Group II). The external fixator was removed when the measurement outcome (LS < 10%) was consistent with the surgeon's diagnosis based on the clinical and radiological assessment (bone union achieved).
RESULTS
No significant difference was found in the fracture healing time (mean 25.3 weeks vs. 24.9 weeks, P > 0.05), frame-wearing duration (mean 25.5 weeks vs. 25.8 weeks, P > 0.05), or LS measurement frequency (mean 1.1 times vs. 1.2 times, P > 0.05). The measurement system installation time in Group I was significantly shorter compared to Group II (mean 14.8 min vs. 81.3 min, P < 0.001). The LS value of the first measurement in Group I was lower than that of Group II (mean 5.1% vs. 6.9%, P = 0.011). In Group I, the refracture rate was 0, but in Group II it was 4.3% (2/47, P > 0.05).
CONCLUSION
The novel hexapod LS-measurement system and involved method demonstrated enhanced convenience and precision in measuring the LS of the external fixator in vivo. The LS measurement indicates the callus stiffness of fracture healing, and is applicable to evaluate the safety of removing the fixator. Consequently, it is highly recommended for widespread adoption in clinical practice.
Topics: Humans; External Fixators; Female; Tibial Fractures; Male; Retrospective Studies; Adult; Fracture Healing; Middle Aged; Fracture Fixation; Device Removal; Weight-Bearing; Young Adult; Aged; Feasibility Studies; Equipment Design
PubMed: 38724941
DOI: 10.1186/s12891-024-07440-y -
BMC Musculoskeletal Disorders May 2024Open tibial fractures often include severe bone loss and soft tissue defects and requires complex reconstructive operations. However, the optimal treatment is unclear.
BACKGROUND
Open tibial fractures often include severe bone loss and soft tissue defects and requires complex reconstructive operations. However, the optimal treatment is unclear.
METHODS
This retrospective study enrolled patients with Gustilo type III open tibial fractures from January 2018 to January 2021 to assess the clinical utility of Masquelet technique together with microsurgical technique as a combined strategy for the treatment of open tibial fractures. The demographics and clinical outcomes including bone union time, infection, nonunion and other complications were recorded for analysis. The bone recovery quality was evaluated by the AOFAS Ankle-Hindfoot Scale score and the Paley criteria.
RESULTS
We enrolled 10 patients, the mean age of the patients and length of bone defects were 31.7 years (range, 23-45 years) and 7.5 cm (range, 4.5-10 cm) respectively. Bone union was achieved for all patients, with an average healing time of 12.2 months (range, 11-16 months). Seven patients exhibited a bone healing time of less than 12 months, whereas 3 patients exhibited a bone healing time exceeding 12 months. No significant correlation was found between the length of bone loss and healing time. In addition, no deep infection or nonunion was observed, although 2 patients experienced wound fat liquefaction with exudates and 1 patient presented with a bloated skin flap. The average AOFAS Ankle-Hindfoot Scale score was 80.5 (range, 74-85), and all patients were evaluated as good or exellent based on the Paley criteria.
CONCLUSIONS
Our study indicated that the use of the Masquelet technique and the microsurgical technique as a combined strategy is safe and effective for the treatment of Gustilo type III open tibial fractures.
Topics: Humans; Tibial Fractures; Male; Middle Aged; Retrospective Studies; Fractures, Open; Adult; Female; Microsurgery; Young Adult; Treatment Outcome; Fracture Healing; Fracture Fixation, Internal; Plastic Surgery Procedures; Bone Transplantation
PubMed: 38714945
DOI: 10.1186/s12891-024-07478-y -
Acta Orthopaedica May 2024We aimed to assess joint failure rate, i.e., subsequent conversion to TKA after surgical treatment of a tibial plateau fracture (TPF). Secondary aims were to explore the... (Observational Study)
Observational Study
BACKGROUND AND PURPOSE
We aimed to assess joint failure rate, i.e., subsequent conversion to TKA after surgical treatment of a tibial plateau fracture (TPF). Secondary aims were to explore the association between joint failure and fracture type, and to determine the risk of failure associated with inadequate joint surface reduction.
METHODS
We included all patients ≥ 18 years of age with a surgically treated TPF, treated at Uppsala University Hospital between 2002 and 2015. All fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Traumatology Association (AO/OTA) classification. Postoperative radiographs were evaluated to determine the quality of joint surface inadequate reduction, defined as an articular step-off ≥ 2 mm. The study cohort was linked with the Swedish Arthroplasty Register (SAR) for information on subsequent total knee arthroplasty (TKA).
RESULTS
439 patients (57% women) with a mean age of 55 years (SD 17) were included. According to the AO/OTA classification, the fracture distribution was B1: 4.8%, B2: 10%, B3: 47%, C1: 12%, C2: 6.4%, and C3: 19%. 23 patients (5.2%) were converted to a TKA within 2 years of initial surgery, and 34 patients (7.7%) had been converted by the end of follow-up (16 years). AO/OTA type B3 and C3 had a 6.8 (95% confidence interval [CI] 1.6-29) times greater risk of joint failure compared with B1-2 and C1-C2 at 2 years' follow-up. Inadequate joint surface reduction led to an 8.4 (CI 3.6-20) times greater risk of conversion to TKA at 2 years' follow-up.
CONCLUSION
Overall, 5.2% were converted to a TKA within 2 years. Fracture types AO/OTA B3 and C3 with a comminuted articular surface and inadequate joint surface reduction were strongly associated with joint failure.
Topics: Humans; Female; Tibial Fractures; Arthroplasty, Replacement, Knee; Middle Aged; Male; Aged; Adult; Reoperation; Cohort Studies; Fracture Fixation, Internal; Risk Factors; Sweden; Tibial Plateau Fractures
PubMed: 38712764
DOI: 10.2340/17453674.2024.40605 -
Frontiers in Bioengineering and... 2024After femoral oncological knee arthroplasty, some patients suffer from rotating axis fracture, which significantly impacts the life span of the rotating hinge knee (RHK)...
BACKGROUND
After femoral oncological knee arthroplasty, some patients suffer from rotating axis fracture, which significantly impacts the life span of the rotating hinge knee (RHK) prosthesis. This research aimed to analyze the biomechanical response of anatomical gastrocnemius reconstruction and assess whether it could reduce the risk of rotating axis breakage by finite element (FE) analysis.
METHODS
A femur-prosthesis-tibia FE model was established using the data from CT scans. The mechanical properties of the RHK implant were quantitatively compared before and after gastrocnemius reconstruction at 6 angles: 10°, 20°, 30°, 40°, 50°, and 60°.
RESULTS
Our results showed that gastrocnemius reconstruction effectively altered the stress distribution around the rotating axis, considerably relieving the stress in the fracture-prone region. In addition, the peak stress in the rotating axis, bending axis, prosthesis stem, and femoral condyles decreased variably.
CONCLUSION
In distal femoral resection knee arthroplasty, the rebuilding of gastrocnemius substantially improved the stress distribution within the prosthesis, thereby having the potential to reduce the risk of prosthetic fracture and prolong the overall durability of the prosthesis.
PubMed: 38707499
DOI: 10.3389/fbioe.2024.1391298