Short-term results of grade III open tibia fractures treated with circular fixators

Nieuwoudt, Luan; Ferreira, Nando; Marais, LC

doi:10.17159/2309-8309/2016/v15n3a2

Cited by 8 publications

(16 citation statements)

References 33 publications

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“…The rate of chronic osteomyelitis following Gustilo-Anderson IIIB fractures in our study was 1.4%. This compares favourably to 31,38,40,42 Our data failed to show any statistically significant complications in patients infected with HIV. The final outcomes were also not affected by HIV infection.…”

Section: Discussionsupporting

confidence: 58%

“…Our results are comparable to results quoted in international literature. [32][33][34][35][36][37][38][39] The relatively low rate of failed limb salvage (our amputation rate was 1%) observed in our study points to the fact that ring fixation is a safe and effective treatment modality. It may also indicate a relatively conservative approach to patient selection for limb salvage and that our unit could consider a more aggressive approach in attempting limb salvage instead of early amputation.…”

Section: Discussionmentioning

confidence: 49%

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An audit of circular external fixation usage in a tertiary hospital in South Africa

Walt¹,

Ferreira²

2018

SA orthop. j.

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Background: Circular external fixation is a well-known treatment modality in reconstructive orthopaedic surgery and is frequently used for deformity correction, limb lengthening, limb salvage, and complex diaphyseal and periarticular fractures. The current use of this treatment modality in the South African context remains largely unknown. This retrospective review aims to describe the indications, outcomes and complications of the use of circular external fixation in a tertiary hospital in South Africa. Materials and methods: We retrospectively reviewed the records of 480 patients treated with circular external fixation in a specialist limb reconstruction unit. We report on patient demographics, comorbidities, indications and outcomes. Results: The final cohort consisted of 346 men and 134 women with a mean age of 35.5 years (SD 14.9, range: 5-73). Comorbidities were identified in 163 (34.0%) patients. These included diabetes in 14 (2.9%) patients and smoking in 102 (21%) patients. HIV infection was diagnosed in 120 patients (25%) with a mean CD4 count of 425 cells/mm 3 (SD: 223, range: 82-1056). The mean time in external fixator was 24.6% weeks (SD: 15.3, range 4-159). The treatment objective was achieved in 441 patients (92%). The overall complication rate excluding pin-site infection was 26%. Pin-site infection occurred in 88 patients (18.3%) but had no impact on the outcome of treatment. Conclusion: Circular external fixation treatment objectives can be achieved in a high percentage of patients in the context of a South African specialist reconstruction unit. This study shows favourable outcomes in deformity correction, limb lengthening, limb salvage, and complex diaphyseal and periarticular fractures. Comorbid factors, including HIV, diabetes and smoking had no effect on achieving the planned outcomes, but smoking did increase the overall time in external fixator.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 49%

An audit of circular external fixation usage in a tertiary hospital in South Africa

Walt¹,

Ferreira²

2018

SA orthop. j.

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“…15 These findings were echoed by Niewoudt et al, who noted that HIV did not appear to be associated with an increased risk of deep infection or non-union in grade III open tibia fractures treated with circular external fixation. 16 The influence of CD4 count on the development of infection also remains unclear. Guild et al, showed an increased infection rate in patients with a CD4 count below 300.…”

Section: Discussionmentioning

confidence: 99%

Reactivation of chronic haematogenous osteomyelitis in HIV-infected patients

Siyo

Marais

2019

SA orthop. j.

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Background: The aim of the study is to determine the prevalence of HIV infection among adult patients with reactivation of haematogenous chronic osteomyelitis. Methods: A retrospective analysis of prospectively collected data from 143 adult patients with chronic osteomyelitis. Results: A total of 143 patients were included in the study group, with a mean age of 38 years (range 14-78 years). Twenty-two per cent (n=31) of patients were diagnosed with reactivation of chronic haematogenous osteomyelitis, while 78% of patients had contiguous chronic osteomyelitis (29% [n=42] post-operative and 49% [n=70] post-traumatic, respectively). Forty (28%) patients were found to be HIV positive with a mean CD4 count of 414 cells/mm³ (range 13-1 034 cells/mm³). Twenty-four (60%) of patients with HIV were on antiretroviral therapy at time of diagnosis. The prevalence of HIV infection among patients with contiguous (post-operative or post-traumatic) infections was 32%, in comparison to 13% in the group with reactivation of chronic haematogenous infections (p=0.04; OR 3.2; 95% CI 1.0-9.8). Conclusion: The prevalence of HIV infection among patients with reactivation of chronic haematogenous osteomyelitis appeared to be lower than that seen in patients with chronic osteomyelitis from other causes and lower than that seen in the general population in South Africa.

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“…96 Circular external fixation has demonstrated its effectiveness in the management of complex open tibia fractures in both civilian and war injuries. [97][98][99][100] They utilise indirect reduction techniques with fine wires and/or half pins and small incisions, which ensure minimal soft-tissue damage and soft-tissue footprint. 4 Treatment with circular external fixation, which does not place any hardware at the fracture site, may reduce infections and hospital readmissions.…”

Section: Skeletal Stabilisationmentioning

confidence: 99%

“…Nieuwoudt et al reported excellent short-term results with low infection and non-union rates on 94 consecutive grade III open tibia fractures treated with circular external fixation followed up for a period of 12 months. 100 The majority of patients were treated in traditional Ilizarov fixators. Hexapod external fixators were used in 12 patients.…”

Section: Skeletal Stabilisationmentioning

confidence: 99%

Current concepts in the management of open tibia fractures

et al. 2019

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Open tibia fractures are associated with an increased risk of infection, delayed union, non-union and wound complications. Management is aimed at mitigating the risk of infection while optimising the biological and biomechanical environment to encourage soft tissue and bone healing. With ongoing clinical trials and research, our knowledge around best clinical practice continues to evolve. Multiple consensus documents and protocols have been formulated, yet some controversy exists around the ideal management for high risk grade III injuries. Early antibiotic therapy has become a cornerstone in the management of these injuries. However, some controversy remains around the type and duration of antibiotic therapy. Emergent debridement and lavage is a critical factor in treatment success. Intramedullary nailing is a viable fixation option for most open tibia fractures while circular external fixation has gained prominence in the management of high energy grade III injuries, especially in the presence of bone and soft tissue loss. The timing of the various treatment interventions continues to provoke debate and controversy. Considering the available literature, the local context needs to be considered. Inadequate access to theatre, shortage of staff, resources and expertise are frequently encountered. We aim to elucidate current literature with regard to the management of open tibia fractures guided in part by various consensus documents and protocols.

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Short-term results of grade III open tibia fractures treated with circular fixators

Cited by 8 publications

References 33 publications

An audit of circular external fixation usage in a tertiary hospital in South Africa

An audit of circular external fixation usage in a tertiary hospital in South Africa

Reactivation of chronic haematogenous osteomyelitis in HIV-infected patients

Current concepts in the management of open tibia fractures

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