Objective: Socket prosthesis attachment is the current gold standard for limb amputees. Osseointegrated implantation is a novel technique that has many proposed advantages over the current gold standard. Clear advantages for its use over socket prosthetic attachment has been well established in literature. It decreases socket problems as pinching, pressure points, chronic skin problems and frequent socket change due to atrophy of muscles. Methods: We reviewed primary research articles documenting complication rates and outcome measures in patients with osseointegrated prosthesis implantation after limb amputation. Results: Nine studies were identified with a total of 211e242 patients. Clinical, radiographic, and functional outcomes, as well as complications were considered. The mean duration of follow-up was greater than 12 months in all studies. Conclusions: Osseointegration is an effective alternative to socket prosthesis in transfemoral amputees. Transtibial and upper extremity implants are underreported in the literature and clear indication for their effectiveness over socket prosthesis does not exist. Minor complications are most common, such as soft tissue infections, and may be mitigated in the future by improvements in surgical technique and implant design. The level of evidence is 3.
Background: Open tibial plafond fractures (Orthopaedic Trauma Association and AO Foundation [OTA/AO] 43) are associated with severe complications, including deep infection (closed fractures, 20%; open fractures, 30%), amputation (3%-14%), and nonunion (up to 25%). Circular external fixators (CEFs) can minimize soft tissue injury. This study aimed to report the rate of union and occurrence of severe complications in patients with open tibial plafond fractures treated with CEFs. Methods: A retrospective review of case series was conducted at 3 level I trauma centers. The study included patients older than 18 years with open tibial plafond fractures treated with CEFs. The reported outcomes included union rate, deep infection, operative complications, and limb alignment. The radiographic measurements of anatomic alignment were obtained. Fifty-two patients were included in the study. Results: The primary union rate was 79%. No deep infection occurred in the majority (92%) of patients. No patient required amputation of the affected limb or free flap coverage. Conclusion: Definitive fixation of open tibial plafond fractures with CEFs avoided severe soft tissue complications but resulted in variation in final radiographic alignment. Level of Evidence: Level IV, case series.
Background: High-pressure injections injuries to the extremities can result in significant disability, including amputation of the affected limb. Proprietary mixtures associated with drill mud and hydraulic fracking leads to frequent encounters with varied materials. The physician needs to be aware of the effect of these materials when inadvertent exposure occurs. Injected toxic materials cause extensive soft tissue inflammation and destruction. This puts the foot at risk not only to the cleaning fluid used, generally water, but any contaminant on the boot at the time of injury. This case report is the first known case report involving injection with drill mud contaminant and describes 2 oil field injuries resulting in the gross deep contamination of the foot from a high-pressure washer injury. Case Report: Two patients, a 46-year-old man (patient 1) and a 29-year-old man (patient 2) sustained high-pressure injection injuries to the foot. These patients underwent treatment with immediate broad-spectrum antibiotics and emergent irrigation and debridement on arrival to the treating facility. Neither patient underwent amputation of the affected extremity as a result of their injuries and achieved a full recovery and return to work. Conclusion: High-pressure injection injuries are operative emergencies. Treatment should include tetanus prophylaxis, neurovascular monitoring, broad-spectrum antibiotic coverage, emergent operative debridement for toxic materials. Despite the toxic nature of the injection injuries, aggressive treatment can improve the chance of salvage in these industrial injuries.
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