Changing the treatment to reduce complication rate in open tibial fractures

Abstract

Complications of open tibial fractures have been found to be very frequent after application of monotherapies (external fixator, plate, intramedullary nailing). The use of combined therapy has improved our results. We treated 658 patients for open tibial fractures over a course of 15 years. Plating was the method of treatment in the initial phase, and then external fixators and unreamed tibial nails (UTN) were used as a monotherapy. In the last ten years the option of a combined therapy was at our disposal, namely, changing the method of treatment. Monotherapy was performed in 352 cases, and 270 patients were treated in a combined manner. The rate of septic complications could be reduced with the combined therapy from 15.5% to 6.6%, the rate of bone healing disorders from 31.6% to 8.7%, and that of amputations from 4.9% to 0.7%. Elaboration of therapeutic tactics and their consistent application increases the healing potential of open tibial fractures. During this 15 year period, our therapeutic concepts have changed, whereby gradual, combined therapy models were initiated, increasing the advantages and decreasing the disadvantages of the different methods.Résumé Les complications après fractures ouvertes du tibia sont très fréquentes quel que soit le traitement: fixateur externe, plaque, enclouage centro-médullaire. Les traitements combinés permettent d'améliorer les résultats. Nous avons traité 658 patients présentant une fracture ouverte du tibia sur une période de 15 ans. Ces patients ont d'abord été traités, au début de notre expérience, par ostéosynthèse par plaque et, plus tard, par fixateur externe ou par clou centromédullaire sans alésage. Dans les 10 dernières années, nous avons préféré combiner les traitements. Un traitement unique a été réalisé chez 352 patients et des traitements combinés chez 270. le taux de complications septiques a diminué du fait des traitements combinés de 15,5 à 6,6%, les problèmes de complications osseuses ont diminué de 31,6 à 8,7% de même en ce qui concerne les amputations qui ont également diminué de 4,9 à 0,7%. l'indication thérapeutique est un élément important du traitement notamment pour obtenir une bonne guérison dans les fractures ouvertes du tibia. Sur une période de 15 ans notre concept thérapeutique a changé en passant de traitements uniques à des traitements combinés. Ceux-ci permettent d'améliorer les avantages de chaque méthode et de diminuer leurs inconvénients.

Wound healing and all‐cause mortality in 958 wound patients treated in home care

“…Among the investigated categories, surgical wounds were associated with the most favorable prognosis; however, after the first 3 weeks of therapy, surgical wounds that persisted became as difficult to heal as other wounds. Prolonged wound care after surgery may be inevitable due to the nature of the procedure performed and the method applied, for example, in closure by secondary intention, or might be caused by complications and adverse events of the surgery, for example, in wound infections and soft tissue skin necrosis . Nonetheless, our results indicate that after 3 weeks of therapy, healing of surgical wounds becomes a challenge in a routine home‐care setting.…”

“…Prolonged wound care after surgery may be inevitable due to the nature of the procedure performed and the method applied, for example, in closure by secondary intention, or might be caused by complications and adverse events of the surgery, for example, in wound infections and soft tissue skin necrosis. [22][23][24][25] Nonetheless, our results indicate that after 3 weeks of therapy, healing of surgical wounds becomes a challenge in a routine home-care setting. Figure 2.…”

Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials

“…The aims of treatment for tibial shaft fractures are re-establishing pre-injury anatomy and function with lower complication rates [3]. Several methods have been used for treatment of this fracture, including compression plating, reamed or unreamed intramedullary nailing and external fixation [4,5].…”