Surgical treatment of wounds, external fixation, leaving the wounds open and performing necessary debridements, adequate drug therapy administration are essential for obtaining good results in patients with open tibial shaft fractures.
Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies.
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.
Injury to the anterior cruciate ligament (ACL) of the knee is the most common ligament injury that requires operative treatment. Patient treatment can be non-operative and operative. So far, multiple ACL reconstruction (ACLR) techniques using a variety of graft types and implants that fixate the grafts have been described. Since 1995, titanium buttons with a loop have been used as implants for suspensory fixation of the graft in the femoral tunnel during ACLR. There are two types of titanium buttons in use: one with a fixedlength loop and the other with an intraoperative adjustable-length loop. This randomized prospective study presents a comparative analysis of results after ACLR using two implant types for suspensory graft fixation in the femoral tunnel. The post-operative knee stability was assessed 24 months after surgery using the Lachman test and the lateral pivot shift test, as well as the KT-1000 arthrometer test. In patients whose graft was fixated using a fixedlength loop implant, the mean post-surgery knee stability, measured with the KT-1000, was 1.167 +/-0.780; in patients whose graft was fixated using an adjustable-length loop implant, the mean value was 1.100+/-0.894 (P=0.605). The mean post-surgery IKDC score for the fixed-length loop group was 84.887 +/-9.0207, while for the adjustable-length loop the score was 88.327 (+/-7.302). The mean Lysholm score was 93.50+/-6.872 for the fixedlength loop group of patients and 94.00 +/-5.527 for the adjustable-length loop group. The results of this study lead to a conclusion that both types of implants can be used with success during ACLR, because the functional results of operative treatment using both implants were identical after surgery.
Background Distally based sural neurofasciocutaneous (NFC) flaps are a commonly used method for foot and ankle reconstruction given that they are much simpler and, at the same time, still efficient alternative to perforator flaps and free style free flaps. Objective This study aims to evaluate the reliability and versatility of reverse sural island NFC flaps as a powerful and efficient method that can be used for repair of lower leg skin defects. This method does not require microsurgical facilities or extensive training. Methodology Patients with soft tissue defects of the distal third of the leg and ankle region received reverse sural island NFC flaps. Inclusion criteria included an absence of damage to the sural neurovascular axis or communicating perforators, absence of peripheral vascular disease, and the presence of soft tissue defects deep enough to expose tendon or bone. Patients were assessed for flap (defect) size, pedicle length and location of defects, postoperative flap survival rates, and complications. Donor sites were closed directly or skin grafted. Results Of 24 consecutive patient (20 male; 4 female), all flaps except 1 (4.16%), survived, although partial necrosis was observed in 2 patients (8.33%). The overall major complication rate was 12.50%. Epidermolysis was noted in 1 patient (4.16%). Three cases of transient venous congestion resolved without additional complications. The overall minor complication rate was 16.66%. Minimal complications were associated with healing of donor sites. Conclusions Reverse sural island NFC flaps provide adequate and aesthetically very acceptable coverage of soft tissue defects of the distal lower leg and proximal foot with no functional impairment.
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