Intentional Temporary Limb Deformation for Closure of Soft-Tissue Defects in Open Tibial Fractures

Hernández-Irizarry, Roberto; Quinnan, Stephen M.; Reid, J. Spence; Toney, Clarence Brian; Rozbruch, S. Robert; Lezak, Bradley; Fragomen, Austin T.

doi:10.1097/bot.0000000000001988

Cited by 11 publications

(18 citation statements)

References 33 publications

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“…These include acute shortening, primary shortening, acute deformation, angular shortening, intentional temporary deformation, intentional deformation, intentional temporary shortening and deformation, shortening with angulation and rotation, etc. 9 , 11 , 12 , 14 , 18 , 24 , 26 , 27 , 32 – 34 We propose the above-mentioned terms can be replaced by one term, “Artificial Deformity Creation” or ADCr, which can include techniques of shortening, angulation and rotation either separately or in combination.…”

Section: Discussionmentioning

confidence: 99%

“…Four authors 15 , 22 – 24 have suggested, for a one-step acute shortening, a specific value of 3 cm. Three authors 25 – 27 propose to base the decision on the state of soft tissues and the vascular status of the injured limb, as well as on the results of pulse oximetry and intraoperative Doppler sonography. According to Atbasi et al and Hernández-Irizarry et al, the criterion for the limit of acute shortening is the beginning of changes in Doppler and pulse oximetry.…”

Section: Discussionmentioning

confidence: 99%

“…The Taylor spatial frame (TSF) was the only hexapod system described in the literature review. 11 – 13 , 15 , 27 , 43 , 44 The uses of the TSF for the correction of temporary deformities created for closing soft tissue defects have the following disadvantages:…”

Section: Discussionmentioning

confidence: 99%

“… 25 Other authors have proposed to control the safety of acute shortening by using intraoperative Doppler sonography and by monitoring blood flow in the distal vessels ( a. dorsalis pedis and a. tibialis posterior ), or with pulse oximetry on the big toe. 26 , 27 …”

Section: R Esultsmentioning

confidence: 99%

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Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature

Соломин¹,

Plotnikovs²,

Movcans³

2022

Strategies in Trauma and Limb Reconstruction

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A bstract Introduction The presence of massive soft tissue loss in open tibial fractures is a challenging problem. Acute limb shortening is an alternative solution in situations where the use of flaps is limited. Materials and methods A review was conducted following the Preferred Reported Items for Systematic Reviews and Meta-analyses checklist (PRISMA) guidelines. A complete search of PubMed, EMBASE and MEDLINE was undertaken. Twenty-four articles related to closure of soft tissue defects through acute limb shortening were identified and included in this review. Results All report on restoration of limb function without or with minimal residual shortening. The authors note a decrease in the need for microsurgery. The external fixation devices used for deformity correction after closure of the soft tissue defect by acute shortening, angulation and rotation were the Ilizarov apparatus and circular fixator hexapods mainly. Conclusion Acute shortening is an alternative to microsurgical techniques. A ring external fixator is useful for restoring limb alignment after closing the soft tissue defect through creating a temporary deformity. The use of circular fixator hexapods can enable accurate correction of complex multicomponent deformities without the need to reassembly of individual correction units. How to cite this article Plotnikovs K, Movcans J, Solomin L. Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature. Strategies Trauma Limb Reconstr 2022;17(1):44–54.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

See 2 more Smart Citations

Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature

Соломин¹,

Plotnikovs²,

Movcans³

2022

Strategies in Trauma and Limb Reconstruction

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show abstract

“…In these settings, surgeons have to find innovative ways of using available technology and consumables to circumvent the lack of resources that may be readily available in high-income countries (HICs) [ 1 ]. One such example is deformity-assisted wound closure to manage open fractures with skin loss to compensate for the lack of plastic and micro-vascular surgical capabilities ( Figure 1 ) [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Limb reconstruction in a resource-limited environment

Ferreira

Sabharwal

Hosny

et al. 2021

SICOT-J

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Introduction: Limb salvage and reconstruction are often challenging and even more so in the limited resource setting. The purpose of this narrative review is to explore the strategies for addressing the unique obstacles and opportunities of limb reconstructive surgery in resource-limited environments globally. Methods: We review (1) the global burden and dimension of the problem, (2) the relevance of orthopedic forums and communication, (3) free and open-access software for deformity analysis and correction, (4) bidirectional learning opportunities, and the value of fellowships and mentoring between resource-rich and resource-limited countries, and (5) how societies like SICOT can help to tackle the problem. Finally, case examples are presented to demonstrate the choice of surgical implants, their availability in regions with limited resources, and how the universal principles of limb reconstruction can be applied, irrespective of resource availability. Results: Limb reconstruction can often be life-changing surgery with the goals of limb salvage, improved function, and ambulation. The contradiction of relatively few severe limb deformities in high-income countries (HICs) with abundant resources and the considerable burden of limb deformities in resource-limited countries is striking. Free, open access to education and software planning tools are of paramount importance to achieve this goal of limb reconstruction. Bidirectional learning, i.e., knowledge exchange between individual surgeons and societies with limited and abundant resources, can be reached via fellowships and mentoring. The presented cases highlight (1) fixator-assisted wound closure obliviating the need for plastic surgery, (2) open bone transport, and (3) hinged Ilizarov frames for correction of severe deformities. These cases underline that optimal clinical outcome can be achieved with low-cost and readily available implants when the principles of limb reconstruction are skillfully applied. Discussion: Limb lengthening and reconstruction are based on universally applicable principles. These have to be applied regardless of the planning tool or surgical implant availability to achieve the goals of limb salvage and improved quality of life.

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The Ilizarov Method for the Management of Bone Tumors in the Lower Extremity: Techniques, Indications, and Outcomes

Groszman

Nooh

Bernstein

et al. 2023

SN Compr. Clin. Med.

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Intentional Temporary Limb Deformation for Closure of Soft-Tissue Defects in Open Tibial Fractures

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 11 publications

References 33 publications

Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature

Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature

Limb reconstruction in a resource-limited environment

The Ilizarov Method for the Management of Bone Tumors in the Lower Extremity: Techniques, Indications, and Outcomes

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