Two-ring hybrid external fixation of distal tibial fractures: a review of 47 cases.
Journal - The Journal of trauma (United States )
BACKGROUND: The healing of a metaphyseal fracture line is a major problem in cases of distal tibial fracture treated with external fixation. METHODS: Forty-seven distal tibial fractures treated with two-ring Ilizarov hybrid external fixation (16 AO/OTA type A and 31 type C, 10 open) were followed up. Fracture reduction and union time was evaluated and IOWA and RAND 36-Item Health Survey scores were used to assess functional outcome. RESULTS: Thirty-five fractures united uneventfully in a median time of 20 weeks, but 12 fractures needed additional procedures because of delayed union. According to univariate analysis, the risk factors for a longer time needed for fracture union were translational displacement and current smoking, and the risk factors for reoperation because of delayed union translational displacement fibular fracture fixation, and the number of cigarettes smoked per day. In multivariate analysis, translational displacement was a risk factor for both longer time to fracture union and reoperation and fibular fracture fixation was a risk factor for reoperation. If the translational displacement was less than 3 mm, the reoperation rate was 6%, whereas if the displacement was more than 3 mm, it was 83%. Reoperation was performed on 50% of the patients who underwent fibular fixation and on 15% of the patients who did not undergo fibular fixation. There were only marginal decreases in the range of motion and arthritis scores in the AO/OTA fracture types other than type C3. There were no significant differences in RAND 36 scores between the general Finnish population aged 18 to 64 years and our patients. CONCLUSIONS: Hybrid external fixation of distal tibial fractures is associated with delayed union, which is closely related to the degree of residual translational displacement after reduction. Fixation of an associated fibular fracture does not help to achieve better contact in the tibial fracture and increases the risk of delayed union.
|ISSN : ||0022-5282|
|Mesh Heading : ||Adolescent Adult Aged Ankle Injuries Case-Control Studies Female Follow-Up Studies Fracture Fixation Fracture Healing Fractures, Ununited Humans Male Middle Aged Range of Motion, Articular Risk Factors Tibial Fractures Treatment Outcome radiography epidemiology radiography|
|Mesh Heading Relevant : ||External Fixators surgery methods surgery|
External fixation of tibial pilon fractures and fracture healing.
Journal - Acta orthopaedica. Supplementum (Sweden )
Distal tibial fractures are rare and difficult to treat because the bones are subcutaneous. External fixation is commonly used, but the method often results in delayed union. The aim of the present study was to find out the factors that affect fracture union in tibial pilon fractures. For this purpose, prospective data collection of tibial pilon fractures was carried out in 1998-2004, resulting in 159 fractures, of which 83 were treated with external fixation. Additionally, 23 open tibial fractures with significant > 3 cm bone defect that were treated with a staged method in 2000-2004 were retrospectively evaluated. The specific questions to be answered were: What are the risk factors for delayed union associated with two-ring hybrid external fixation? Does human recombinant BMP-7 accelerate healing? What is the role of temporary ankle-spanning external fixation? What is the healing potential of distal tibial bone loss treated with a staged method using antibiotic beads and subsequent autogenous cancellous grafting compared to other locations of the tibia? The following risk factors for delayed healing after external fixation were identified: post-reduction fracture gap of >3 mm and fixation of the associated fibula fracture. Fracture displacement could be better controlled with initial temporary external fixation than with early definitive fixation, but it had no significant effect on healing time, functional outcome or complication rate. Osteoinduction with rhBMP-7 was found to accelerate fracture healing and to shorten the sick leave. A staged method using antibiotic beads and subsequent autogenous cancellous grafting proved to be effective in the treatment of tibial bone loss. Healing potential of the bone loss in distal tibia was at least equally good as in other locations of the tibia.
|ISSN : ||1745-3690|
|Mesh Heading : ||Adolescent Adult Aged Anti-Bacterial Agents Bone Morphogenetic Protein 7 Bone Morphogenetic Proteins Bone Transplantation Case-Control Studies Diaphyses Equipment Design External Fixators Female Fracture Fixation Fracture Healing Fractures, Closed Fractures, Open Fractures, Ununited Humans Male Middle Aged Postoperative Complications Prospective Studies Retrospective Studies Risk Factors Tibial Fractures Transforming Growth Factor beta Transplantation, Autologous Treatment Outcome therapeutic use therapeutic use injuries adverse effects adverse effects instrumentation drug effects surgery surgery etiology physiopathology therapeutic use|
|Mesh Heading Relevant : ||methods physiology surgery|
Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss: 22 of 23 fractures healed after 5-20 months.
Journal - Acta orthopaedica (Sweden )
INTRODUCTION: The vascularity of surrounding soft tissues, which is related to muscle cover, is important for the healing of traumatic bone loss. Muscle cover on the distal tibia is limited compared to the diaphyseal and proximal tibia, and delayed healing of fractures in this area is common. We evaluated the healing of traumatic bone loss in the proximal, diaphyseal, and distal tibia. PATIENTS AND METHODS :23 open tibial fractures with substantial bone loss (mean 52 (34-104) mm) were treated using a staged method with antibiotic-impregnated beads and later autologous bone grafting at second-stage surgery on average 8 weeks after the injury. RESULTS: 22 fractures healed after mean 40 (20-79) weeks. The average healing time in the distal tibia (mean 30 weeks) was 7 weeks shorter (95% CI: 12-26 weeks) than in the proximal tibia (37 weeks), and 16 weeks shorter (95% CI: 3-29 weeks) than in the tibial shaft (47 weeks). The length of the bone and the type of soft tissue cover (free muscle or secondary suture) had no effect on healing time. INTERPRETATION: Our study suggests that the method we used is applicable in all parts of the tibia, although the healing of bone loss is slower in the diaphyseal tibia than in the proximal and distal tibia.
|ISSN : ||1745-3674|
|Mesh Heading : ||Adolescent Adult Aged Anti-Bacterial Agents Bone Nails Bone Transplantation External Fixators Female Fracture Fixation Fracture Healing Fractures, Open Humans Male Middle Aged Retrospective Studies Tibial Fractures Time Factors Transplantation, Autologous Treatment Outcome surgery|
|Mesh Heading Relevant : ||administration & dosage methods methods surgery|