The management of fractures with soft-tissue disruptions.

Sanders, Richard A.; Swiontkowski, Marc F.; Nunley, James A.; Spiegel, Phillip G.

doi:10.2106/00004623-199305000-00020

Cited by 101 publications

(47 citation statements)

References 41 publications

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“…Significant rates of infection, nonunion, and delayed union are reported complications related to the treatment of open tibia fractures [10,24]. Some continue to advocate some type of external fixation as the treatment of choice for an open tibia fracture.…”

Section: Introductionmentioning

confidence: 99%

“…This degree of reaming caused thermal damage to the bone, increased rates of infection, and subsequently decreased union rates [3,5,12,18,24]. As a result, smallcaliber nails (8-9 mm) were inserted without reaming in order to avoid thermal injury and to minimize disruption to the remaining tibial blood supply [5,23].…”

Section: Introductionmentioning

confidence: 99%

“…These problems seemed to be related to the small caliber of the nail and locking bolts and were especially apparent in axially unstable fractures [5,24]. As the thermal and biologic impact of various degrees of reaming was elucidated, more recent techniques of tibial nailing have suggested that "minimal reaming" may offer advantages over both aggressively reamed and nonreamed techniques [15,24,26]. With this technique, reaming is done only to widen the diaphyseal region by eliminating easily removable bone.…”

Section: Introductionmentioning

confidence: 99%

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Intramedullary nailing in open tibia fractures: a comparison of two techniques

Ziran

Darowish

Klatt

et al. 2004

International Orthopaedics (SICOT)

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We analyzed 51 patients with open tibial fractures treated with intramedullary nailing. In 29 patients the nailing was performed without reaming and in 22 after the "reamed-to-fit" technique. There was no statistically significant difference in the rate of union. The nonreamed group required a greater number of secondary procedures to achieve union and had a higher but not statistically significant incidence of infection. Analysis of the operative and anesthesia cost associated with the additional procedures revealed that on average, patients receiving nonreamed nailing incurred a cost of $4,900 more per fracture than patients of the reamed-to-fit technique. The healing rates of open tibia fractures using either minimally reamed or nonreamed techniques of intramedullary nailing are comparable. No increase in the rate of infection with the reamed-to-fit technique was found. A significant increase in the number of secondary procedures required to achieve union was found with the nonreamed nailing technique.Résumé Nous avons analysé 51 malades avec une fracture tibiale ouverte traitée par enclouage centromédul-laire. Pour 29 malades l'enclouage a été exécuté sans alésage et pour 22 avec la technique d'alésage adapté. Il n'y avait aucune différence statistique dans le taux de consolidation. Le groupe sans alésage a exigé un plus grand nombre de gestes secondaires pour obtenir la consolidation et avait un plus grande fréquence d'infection sans que cela soit statistiquement significatif. L'analyse du coût opératoire et de l'anesthésie, associée aux procédures supplémentaires montre qu'en moyenne un malade traité sans alésage a un coût de €4,100 de plus par fracture que le malade avec la technique d'alésage adapté. es taux de consolidation des fractures tibiales ouvertes en utilisant l'enclouage avec alésage adapté ou les techniques sans alésage sont comparables. Aucune augmentation dans le taux d'infection avec la technique d'alésage adapté n'a été trouvée. Une augmentation notable du nombre de procédures secondaires nécessaires pour obtenir la consolidation a été notée avec la technique de l'enclouage sans alésage.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intramedullary nailing in open tibia fractures: a comparison of two techniques

Ziran

Darowish

Klatt

et al. 2004

International Orthopaedics (SICOT)

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“…2 Inadequate debridement predisposes to infection, both in soft tissues and bone, which prejudices the repair of fractures. 3 There are well-established criteria for the intraoperative determination of muscle viability, 4 but not at present for bone. Those fragments with a reasonable soft-tissue attachment are believed to maintain a blood supply which is sufficient to ensure viability.…”

mentioning

confidence: 99%

“…Those fragments with a reasonable soft-tissue attachment are believed to maintain a blood supply which is sufficient to ensure viability. 3 Many techniques have been used for determining blood flow to bone. These include MRI, 5 radioactive tracer techniques (including the use of microspheres), 6,7 laser Doppler flowmetry (LDF), 8 measurement of the oxygen tension 9 and microangiography.…”

mentioning

confidence: 99%

Evaluation of the viability of bone fragments

Hobbs

Watkins

2001

The Journal of Bone and Joint Surgery. British volume

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W e used laser Doppler flowmetry (LDF) to measure flux in cortical bone fragments as a method of determining their vascular status and viability. In an experimental tibial osteotomy measurements of flux were made from specific cortical sites both before and after osteotomy. Flux levels fell rapidly in non-vascularised fragments and remained significantly reduced throughout the experiment. By contrast, those in vascularised fragments were significantly reduced one and two hours after the osteotomy but then increased. From three hours after the osteotomy there was no significant difference in flux levels between the vascularised fragments and proximal bone stock.We conclude that measurement of bone flux by LDF may have a role in the objective evaluation of the viability of bone fragments, but that further studies are required to validate the technique before its adoption in the management of the injured patient.

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