Twenty-three cases of severeopen commiunted fractures of thetibia and fibula were treated byexternal skelatal fixation and skinflaps.The skin defects were repairedby the facio-cutaneous flaps, themusculo-cutanecus flap of the gast-rocnemius muscle or the vascularizedosteo-cutaneous flap of the ilium.Seventeen cases were followed-upfor an average of 13 months.Clinicalbony union was obtained in anaverage of 110 days. The authorsrecommended that it was a satisfact-ory method of traetment if a thoroughdebridment, reduction and fixation of the fracture by external skeletal fixation and repaire of wound and the skin defects by tissues flaps were carried out.
Objective To compare the hemostatic effects and tourniquet induced side reactions of 2 different tourniquets in internal fixation of bilateral tibia and fibula fracture. Methods Between May 2008 and May 2010, 21 patients with bilateral tibia and fibula fracture were treated and randomly divided into 2 groups according to left and right l imbs. When steel plate fixation was performed, equil ibrium pressure pneumatic tourniquet (EPPT group) and common tourniquet (common group) were used to staunch the flow of blood respectively. The time of using tourniquet was 60 minutes, and the hemostatic pressure was 50 kPa. There were 12 males and 9 females with an age range of 17 to 58 years (mean, 32.5 years). Injurywas caused by traffic accident in 9 patients, by heavy pound in 6 patients, and fall ing from height in 6 patients. According to X-ray calssification, there were 15 cases of simple type, 3 cases of butterfly type, and 3 cases of comminuted type in EPPT group; there were 13 cases of simple type, 5 cases of butterfly type, and 3 cases of comminuted type in common group. The time from injury to operation was 3 to 72 hours (mean, 37.5 hours). Results The time of using tourniquet was (95.30 ± 4.19) minutes in EPPT group and (94.11 ± 5.16) minutes in common group, showing no significant difference (P gt; 0.05). All the incision of 2 groups healed by first intension. After 2 weeks of operation in common group, peroneal nerve injury occurred in 3 cases, and was cured by supporting nerve for 3 months; bl ister occurred in 1 case and was cured after dressing change for 3 weeks; and the injury rate was 19%. No compl ication occurred in EPPT group with an injury rate of 0. There was significant difference in the injury rate between 2 groups (P lt; 0.05). The hemostatic effects were excellent in 19 cases and good in 2 cases of EPPT group, were excellent in 10 cases, good in 3 cases, and poor in 8 cases of common group; the excellent and good rate were 100% and 61.9% respectively, showing significant difference (P lt; 0.05). All patients were followed up 3-24 months. Fracture healed without nonunion and deformity union in 2 groups. Conclusion Comparing to common tourniquet, the EPPT can provide good bloodless field, lower hemostatic pressure, and less tourniquet compl ication.
ObjectiveTo explore the effectiveness of Taylor spatial frame (TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction.MethodsThe clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group (15 cases, open reduction in TSF external fixation) and trial group (15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment.ResultsBoth groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group (P<0.05). There were 2 cases of superficial infection of the external fixation (1 case in each group), 1 case of incision infection (control group), 1 case of delayed fracture healing (control group), 2 cases of traumatic arthritis (1 case in each group); no significant difference was found in the incidence of complications between the two groups (χ2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups (χ2=0.917, P=0.821).ConclusionCompared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation, avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.
ObjectiveTo evaluate the effects of dynamization of external fixation on open tibia and fibula fracture union.MethodsThe clinical data of 26 cases of open tibia and fibula fractures treated by external fixation were retrospectively analysed. According to different postoperative treatment methods, the patients were divided into elastic dynamic group (group A, n=13) and constant elastic fixation group (group B, n=13). There was no significant difference in gender, age, and fracture type between 2 groups (P>0.05). The removal time of external fixator in group B was evaluated by fracture healing time, X-ray film, and doctor’s experience. In group A, the growth of callus was examined based on X-ray film at 12 weeks after operation; the axial mechanical load ratio was tested, and dynamic loading was carried out when the axial mechanical load ratio was 5%-10%. The using time of external fixator, fracture healing time, and incidence of complications were compared between 2 groups.ResultsAll patients were followed up 4-13 months, with an average of 5.7 months. During the treatment, there was no complication such as loosening or breaking of the external fixator, fracture displacement, or re-fracture in 2 groups. The using time of external fixator in group A was (24.77±1.42) weeks and the fracture healing time was (23.04±1.30) weeks, which were all significantly reduced when compared with those in group B [(34.38±1.71) weeks and (32.46±1.66) weeks] (t=16.10, P=0.00; t=15.58, P=0.00). In group A, there were 2 cases of needle tract infection and 1 case of muscle weakness, the incidence of complication was 23.1%; in group B, there were 3 cases of needle tract infection, 1 case of muscle weakness, and 1 case of delayed union of fracture, the incidence of complication was 38.5%; there was no significant difference in the incidence of complication between 2 groups (P=1.000).ConclusionDynamization of external fixation can promote union of open tibia and fibula fractures with a high security.
Objective To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. Methods The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group (26 cases) and external fixation group (48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between 2 groups (P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfenget al. Results Both groups were followed up 6-22 months (median, 14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group (P<0.05). There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups (χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in 19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups (χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al.at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group, with an excellent and good rate of 95.8%; showing no significant difference between 2 groups (χ2=0.520, P=0.471). Conclusion The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.
ObjectiveTo explore the efficacy and safety of the axial load mechanical testing for removing external fixator. MethodsBetween January 2014 and August 2015, 27 patients with tibia and fibula fractures caused by trauma underwent an external fixation. Of 27 patients, 21 were male and 6 were female with the average age of 45 years (range, 19-63 years), including 7 cases of closed fracture and 20 cases of open fracture. X-ray film results showed spiral unstable fracture in 4 cases and comminuted unstable fracture in 23 cases. All patients underwent an external fixation. Bone nonunion occurred in 3 cases because of infection, and bone nonunion combined with bone defect occurred in 1 case, who received tibial osteotomy lengthening surgery. When X-ray film showed continuity high density callus formation at fracture site, axial load mechanical test was performed. If the axial load ratio of external fixator was less than 10%, the external fixator was removed. ResultsAt 21-85 weeks after external fixation (mean, 44 weeks), axial load mechanical test was performed. The results showed that the axial load ratio of external fixation was less than 10% in 26 cases, and the external fixator was removed; at 6 weeks after removal of external fixator, the patients could endure full load and return to work, without re-fracture. The axial load ratio was 14% in 1 case at 85 weeks, and the X-ray film result showed that fracture did not completely heal with angular deformity; re-fracture occurred after removing external fixator, and intramedullary fixation was used. ConclusionExternal fixator axial load mechanical testing may objectively reveal and quantitatively evaluate fracture healing, so it is safe and reliable to use for guiding the external fixator removal.
ObjectiveTo evaluate the effectiveness of one stage vacuum sealing drainage (VSD) combined with bi-pedicle sliding flap transplantation in repairing open tibiofibular fracture and soft tissue defects of the lower leg. MethodsTwenty-five patients with open tibiofibular fracture and soft tissue defects of the lower leg were treated by VSD combined with bi-pedicle sliding flap transplantation between January 2012 and July 2014. There were 18 males and 7 females, aged 12-65 years (mean, 35.2 years). The injury causes included traffic accident injury (20 cases), falling injury from height (3 cases), and heavy pound injury (2 cases). The left side was involved in 14 cases, the right side in 8 cases, and both sides in 3 cases. According to Gustilo classification, injury was rated as type II (6 lower extremities), type III a (19 lower extremities), and type III b (3 lower extremities). The anterior tibial defect area after debridement ranged from 6 cm×3 cm to 12 cm×5 cm. The course of injury and admission was 1-18 hours (mean, 4.5 hours). An anterior tibial bi-pedicle sliding flap of 24 cm×6 cm to 48 cm×8 cm was designed to cover the wound and tibia fracture was fixed with minimally invasive internal fixation. After suturing the anterior tibial wound without tension, the flap was transferred forward. The exposed fibula was fixed with reconstruction plate. The remained wound was covered by VSD. Continuously antibiotic saline irrigation was applied postoperatively. After 15 days, the VSD dressing was removed and free skin graft was used to cover the remained wound. ResultsAfter the VSD dressing was removed, the wounds and tension-reduced wound of 18 lower extremities completely healed. Unhealing wounds were covered by skin graft in 9 lower extremities. Infection occurred in 1 lower extremity and was cured after treated with antibiotics. All the wounds healed and flaps survived. The patients were followed up 6-24 months (mean, 18 months). The fractures union was confirmed by X-ray and the average union time was 3.2 months (range, 2.5-5 months). ConclusionThe application of one stage VSD combined with bi-pedicle sliding flap transposition is a simple and safe treatment regimen for Gustilo type II-IIIa open tibiofibular fracture and soft tissue defects of the lower leg. It has the advantages of few complications and low costs, short hospitalization, and good effectiveness.