Open tibial fractures: An overview

Nicolaides, Marios; Pafitanis, Georgios; Vris, Alexandros

doi:10.1016/j.jcot.2021.101483

Cited by 16 publications

(12 citation statements)

References 124 publications

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“…xation with plate and screws was between 2.3 percent and 2.5 percent [9][10] Debridement was the initial step in the traditional way of treating open tibial fractures, followed by the placement of a large external xator or, where soft tissue injury and contamination were not severe, one stage debridement and internal xation [11][12]. However, due to instability or inconveniency brought on by bulky external xators, internal xation with a plate or intramedullary locking nail may occasionally be required [13].…”

Section: The Infection Incidence For Open Gustilo Type III Tibial Fra...mentioning

confidence: 99%

Treating tibial fracture with supra-cutaneous locking plate osteosynthesis: personalized therapy for special patient;A case series study

Zhang

2022

Preprint

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Background The choice of surgical options for open tibial fractures and closed tibial fractures with soft tissue problems has been controversial.Supra-cutaneous locking plate fixation may be able to provide an personalized treatment plan. Methods After retrospective analysis of the clinical database, we collected data on 19 patients identified as having chronic osteomyelitis after routine surgery for tibial fractures or open tibial fractures.All patients who underwent external fixation with a supra-cutaneous locking plate were followed up for 12.89±3.81 months postoperatively.Further statistical analysis was not performed because the number of cases was too small and the injuries and fracture types were different. Results The postoperative Fugl-Meyer lower limb motor function score was 32.47±3.34 in 19 operated patients, which was evaluated according to the Mazur ankle scoring system: 11 cases were excellent, 5 cases were good, 2 cases were acceptable, and 1 case was poor, with an excellent rate of 84%. The duration of time that passed between the implantation of the supra-cutaneous locking plate and its subsequent removal ranged from 13.00±1.05 months. Conclusions In certain tibial patients with specific indications, such as open tibial fractures without significant bone or soft tissue defect, closed tibial fractures with severe blisters or compromised soft tissue condition, and surgical site infections following tibial internal fixation with no significant bone or soft tissue defect, supra-cutaneous locking plate fixation may be used. It offers sufficient biomechanical stability for fracture repair while minimizing the inconveniences associated with bulky circular frames or external fixators.The supra-cutaneous locking plate fixation used as the final treatment may also result in a little shorter hospital stay for these individuals and lower healthcare expenses.

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Section: The Infection Incidence For Open Gustilo Type III Tibial Fra...mentioning

confidence: 99%

Treating tibial fracture with supra-cutaneous locking plate osteosynthesis: personalized therapy for special patient;A case series study

Zhang

2022

Preprint

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“…Fractures are often combined with severe soft tissue injuries, resulting in extensive soft tissue defects. [1][2][3] Improper treatment can lead to bone infection, osteonecrosis, bone nonunion, and amputation. For large soft tissue defects of the leg and foot, local flaps are limited because of the usually larger size of the defects encountered, such that their donor area is typically compromised.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs

Líu

et al. 2023

Orthopaedic Surgery

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Objective Free flaps are widely used for the repair of soft tissue defects in the lower limbs, but there is still a specific rate of necrosis. Few clinical retrospective studies have analyzed the nontechnical risk factors for lower limb free flap necrosis. This study aimed to analyze the nontechnical causes of flap necrosis in lower limb soft tissue reconstruction in order to identify risk factors and improve the survival rate of free flaps. Methods Clinical data from 244 cases of soft tissue defects of the leg or foot that were repaired with a free flap from January 2011 to June 2020 were retrospectively analyzed. The flap results were divided into complete survival and necrosis groups. The patients' general information, smoking history, soft tissue defect site, Gustilo‐Anderson classification, shock after injury, type and size of the flap, and time from injury to flap coverage were recorded. A logistic regression model was used to analyze the correlations between flap necrosis and possible risk factors. Results Of the 244 flaps, 32 suffered from partial or total necrosis, and 212 completely survived. Univariate analysis showed that age, smoking history, soft tissue defect site, and time from injury to flap coverage were significantly correlated with flap necrosis (p ≤ 0.2). Multivariate logistic regression analysis showed that moderate‐to‐severe smoking history (p < 0.001, odds ratio [OR] = 10.259, 95% confidence interval [CI] = 2.886–36.468), proximal leg defect (p = 0.006, OR = 7.095, 95% CI = 1.731–29.089), and time from injury to flap coverage >7 days (p = 0.003, OR = 12.351, 95% CI = 2.343–65.099) were statistically significant risk factors for flap necrosis (p < 0.05), and age was excluded (p = 0.666; p = 0.924). Conclusion The risk of flap necrosis was significantly increased when the soft tissue defect was located in the proximal leg, the time from injury to flap coverage was >7 days, and the patient had a moderate‐to‐severe smoking history. These three risk factors have an increased influence on flap necrosis and have guiding significance in predicting flap prognosis.

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“…Chronic orthopedic infections are one of the major complications of orthopedic trauma and clinical surgery. [1][2][3][4] It is an urgent need to find effective treatments for these infections. has appropriate mechanical strength to provide mechanical support to weakened bone and consequently reduce fracture pain caused by osteomyelitis.…”

Section: Introductionmentioning

confidence: 99%

“…Chronic orthopedic infections are one of the major complications of orthopedic trauma and clinical surgery. [ 1–4 ] It is an urgent need to find effective treatments for these infections. The radical treatment of chronic osteomyelitis is always long‐term due to severe inflammation at local lesions and a high risk of relapse.…”

Section: Introductionmentioning

confidence: 99%

Peptide Polymer‐Doped Cement Acting as an Effective Treatment of MRSA‐Infected Chronic Osteomyelitis

Ying

Cong

et al. 2021

Adv Funct Materials

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Chronic osteomyelitis is a painful and serious disease normally caused by infected surgical prostheses or infected fractures. Currently, antibioticloaded cements are extensively used as the treatment in clinical practice. However, the quick emergence of antibiotic-resistant bacteria has resulted in a formidable challenge in treating chronic osteomyelitis, such as the chronic osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA). Aiming to address MRSA-infected chronic osteomyelitis, an antibacterial peptide polymer doped polymethylmethacrylate bone cement pellets (PMMA@polymer) is prepared. The peptide polymer is designed as the synthetic mimic of host defense peptide and enables PMMA@polymer to have notable advantages, including complete release of antibacterial agent from PMMA, potent and robust activity against MRSA even after autoclave and enzymatic treatment, and low susceptibility to antibacterial resistance. PMMA@polymer showed potent in vitro activities against MRSA, superior in vivo therapeutic efficacy in a rabbit chronic osteomyelitis model, and low toxicity during the treatment. These advantages and the easy preparation of PMMA@polymer altogether suggest the great potential of PMMA@polymer as an effective treatment of MRSA-infected chronic osteomyelitis. This study opens new avenues in developing antibacterial biomaterials for the treatment of chronic orthopedic infections, frequently caused by drug-resistant bacteria.

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Open tibial fractures: An overview

Cited by 16 publications

References 124 publications

Treating tibial fracture with supra-cutaneous locking plate osteosynthesis: personalized therapy for special patient;A case series study

Treating tibial fracture with supra-cutaneous locking plate osteosynthesis: personalized therapy for special patient;A case series study

Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs

Peptide Polymer‐Doped Cement Acting as an Effective Treatment of MRSA‐Infected Chronic Osteomyelitis

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