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      Outcome of Type 3 Open Tibial Diaphyseal Fractures Managed with a Limb Reconstruction System: Analysis of a 49-Patient Cohort

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          Abstract

          Objective

          To evaluate functional and radiological results following treatment with the single-plane external fixator limb reconstruction system (LRS) for open tibial diaphyseal fractures resulting from high-energy trauma.

          Subjects and Methods

          From a total of 62 patients who were operated on between 2011 and 2014 for open tibial diaphyseal fractures resulting from high-energy trauma, 50 tibias from 49 patients (males: 32, females: 17) were classified as type 3 according to the Gustilo-Anderson open fracture classification, and definitive treatment was applied with the LRS. The patients ranged in age from 20 to 36 years. Time to union, time of external fixator usage, complications and functional results according to the Johner-Wruhs criteria were recorded.

          Results

          The mean follow-up period was 23 ± 12 months (range: 11–44). Of the 50 tibias, full union was achieved with the LRS in 48 (96s%). No shortness or deformity was observed in any patient. Knee and ankle range of movement were measured as full in all patients at the final follow-up examination after removal of the LRS. The mean time to union was 20.4 ± 4 weeks (range: 16–24). The mean time of external fixator use was 20 weeks (range: 16–24 weeks).

          Conclusion

          In this study, for the definitive treatment of open tibia diaphyseal fractures, the LRS was an optimal and safe choice that offered single-stage surgery.

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          Most cited references24

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          Advanced trauma life support, 8th edition, the evidence for change.

          The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.
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            The epidemiology of tibial fractures.

            We performed an epidemiological analysis of 523 fractures treated in the Edinburgh Orthopaedic Trauma Unit over a three-year period using modern descriptive criteria. The fractures were defined in terms of their AO morphology and their degree of comminution, location and cause. Closed fractures were classified using the Tscherne grading system and open fractures according to the Gustilo classification. Further analysis of fractures caused by road-traffic accidents and football was carried out. The use of the AO classification allowed the common fracture patterns to be defined. Correlation of the classification systems showed an association between the AO morphological system and the Tscherne and Gustilo classifications. The relative rarity of severe tibial fractures is indicated and it is suggested that in smaller orthopaedic units the infrequency of these fractures has implications for training and the development of treatment protocols.
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              Management of severe open tibial fractures: the need for combined orthopaedic and plastic surgical treatment in specialist centres.

              Although it is widely accepted that grade IIIB open tibial fractures require combined specialised orthopaedic and plastic surgery, the majority of patients in the UK initially present to local hospitals without access to specialised trauma facilities. The aim of this study was to compare the outcome of patients presenting directly to a specialist centre (primary group) with that of patients initially managed at local centres (tertiary group). We reviewed 73 consecutive grade IIIB open tibial shaft fractures with a mean follow-up of 14 months (8 to 48). There were 26 fractures in the primary and 47 in the tertiary group. The initial skeletal fixation required revision in 22 (47%) of the tertiary patients. Although there was no statistically-significant relationship between flap timing and flap failure, all the failures (6 of 63; 9.5%) occurred in the tertiary group. The overall mean time to union of 28 weeks was not influenced by the type of skeletal fixation. Deep infection occurred in 8.5% of patients, but there were no persistently infected fractures. The infection rate was not increased in those patients debrided more than six hours after injury. The limb salvage rate was 93%. The mean limb functional score was 74% of that of the normal limb. At review, 67% of patients had returned to employment, with a further 10% considering a return after rehabilitation. The times to union, infection rates and Enneking limb reconstruction scores were not statistically different between the primary and tertiary groups. The increased complications and revision surgery encountered in the tertiary group suggest that severe open tibial fractures should be referred directly to specialist centres for simultaneous combined management by orthopaedic and plastic surgeons.
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                Author and article information

                Journal
                Med Princ Pract
                Med Princ Pract
                MPP
                Medical Principles and Practice
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1011-7571
                1423-0151
                April 2016
                10 December 2015
                10 December 2015
                : 25
                : 3
                : 270-275
                Affiliations
                [1] aDepartment of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
                [2] bMetin Sabancı Baltalimanı Bone Disease Training and Research Hospital, Istanbul, Turkey
                Author notes
                *Dr. Ali Çağrı Tekin, Department of Orthopaedics and Traumatology, Okmeydanì Training and Research Hospital, Darülaceze Avenue, No. 25, TR—34384 Şişli/Istanbul (Turkey), E-Mail cagrtekin@ 123456yahoo.com
                Article
                mpp-0025-0270
                10.1159/000443257
                5588381
                26655399
                b4600c40-f8ad-44d8-9959-d72f62ec86a8
                Copyright © 2015 by S. Karger AG, Basel

                This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.

                History
                : 19 March 2015
                : 6 December 2015
                Page count
                Figures: 5, Tables: 1, References: 24, Pages: 6
                Categories
                Original Paper

                open tibia fracture,rigid fixation,single-plane external fixator

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