External fixation of tibial pilon fractures and fracture healing

Ristiniemi, Jukka

doi:10.1080/17453690610046521

Cited by 13 publications

(13 citation statements)

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“…The combined autologous/allogeneic graft showed successful incorporation into the defective pseudarthrosis in 7 out of 9 patients, which was confirmed with the CT scans and plain X-ray film. The problem with the two patients in whom the therapy failed was the poor incorporation of the graft in the distal tibia, where bone healing is compromised through many factors [51].…”

Section: Resultsmentioning

confidence: 99%

Treatment of Bone Defects — Allogenic Platelet Gel and Autologous Bone Technique

Smrke¹,

Rožman²,

Veselko³

et al. 2013

Regenerative Medicine and Tissue Engineering

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Section: Resultsmentioning

confidence: 99%

Treatment of Bone Defects — Allogenic Platelet Gel and Autologous Bone Technique

Smrke¹,

Rožman²,

Veselko³

et al. 2013

Regenerative Medicine and Tissue Engineering

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“…Previous studies have reported satisfactory union rates when using the external fixation strategy as a definitive method of treatment in cases of tibial plafond fractures. 9 Hybrid external fixation systems in cases of tibial plafond fractures allow early mobilization and weight bearing. The use of circular frames is considered to allow better indirect reduction, progressive correction of deformities and offer improved results.…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation

Natera¹,

Gómez²,

Álvarez³

et al. 2016

IJOO

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Background:Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation.Materials and Methods:A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19–82 years). The mean followup was 24 months (range 24–70 months).Results:The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P < 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560).Conclusion:Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external fixation as a definitive procedure might involve a faster union than a two-stage management with final plate fixation.

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“…The type of bone graft used and its impact on time to union has not been described in the literature to date. On the contrary, a study published by Ristiniemi in 2007 concluded that rhBMP-7 accelerated fracture healing and shortened the patients' sick leave [ 9 ]. This study looked at 20 patients who received rhBMP-7 who were matched with 20 patients who didn’t receive rhBMP-7.…”

Section: Discussionmentioning

confidence: 99%

The Role of Circular Frames in the Management of Tibial Fractures

Sheridan

Clesham

Kearns

2018

Cureus

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IntroductionThe purpose of this study is to evaluate the factors that impact the clinical and radiographic outcomes in a patient cohort undergoing external fixation for tibial fractures. We also aim to investigate the use of autograft, allograft, and synthetic bone graft in varying combinations in the setting of tibial bone loss with respect to optimal times to union.MethodsThis was a retrospective study, including 46 patients treated with a circular external fixator for the management of acute tibial fractures. The study was carried out over a 10-year period, between 2007 and 2017, at our institution. The mean follow-up at the time of review was 4.6 years. Primary outcome measures were ‘time to union,’ ‘delayed union’ (> 6 months), ‘infection,’ and ‘duration of external fixation.’ Secondary outcomes included 'length of hospital stay' and functional scores using the 'Short Form-12 (SF-12).' The statistical analysis included both univariate and multivariate analyses to control for confounding variables when assessing predictors of delayed union and infection.ResultsForty-six patients fulfilled the study criteria. Fifteen fractures were classified as open. The mean number of procedures per patient was 3.8 and the mean length of stay per patient was 33 days. The mean time to union was 8.6 months overall. Significant predictors of prolonged time to union were the ‘number of interventions’ (p<0.01) the patient underwent and the ‘bone graft type’ (p<0.01) used. The time to union in the presence of either autograft or allograft was lengthened by the addition of synthetic graft. Five patients developed a deep tissue infection. The use of synthetic bone graft was significantly associated with infection (p<0.05). On subgroup analysis, it was found that the use of synthetic graft in any combination leads to significantly higher rates of deep tissue infection (p<0.05). The mean time to full weight bearing was 10.6 months (s=9.78, 3-36). The majority (57%) were using walking aids and 67% reported that the injury was still affecting their lifestyle.ConclusionTibial fractures with bone loss are a complex group of injuries that often require multiple surgical interventions, prolonged hospital inpatient stay, and suboptimal functional outcomes in many cases. The best times to union are achieved when autograft is used alone without any other combination of bone graft type. The use of synthetic bone graft also significantly increases the rate of deep tissue infection in this cohort. We recommend the use of autograft alone when treating bone defects in tibial fractures with external fixators.

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External fixation of tibial pilon fractures and fracture healing

Cited by 13 publications

References 115 publications

Treatment of Bone Defects — Allogenic Platelet Gel and Autologous Bone Technique

Treatment of Bone Defects — Allogenic Platelet Gel and Autologous Bone Technique

Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation

The Role of Circular Frames in the Management of Tibial Fractures

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