Objective To retrospectively analyze and classify 23 open fractures that resulted in severe infection, in order to provide evidence that can be used in future disaster scenarios. Methods Based on medical records of 23 cases of open fracture and subsequent bacterial infection, we analyzed the clinical diagnosis, treatment, laboratory tests, bacterial smear of wound secretion, and the bacterial culture of the wound secretion. We then analyzed which antimicrobial agents were used and how they were applied, and the subsequent effect on controlling the serious infection.? Results All cases were related to seismic injury and belonged to class VI open fracture. Eight cases were male and 15 were female. All cases had similar symptoms such as chills, fever, large scale muscle necrosis, and severe infection. A direct smear of the wound showed that the number of cases with one bacterial infection was 6 (26.09%), the number that had double bacterial infections was 12 (52.18%), and the number with multiple bacterial infections was 5 (21.74%).There were 18 strains of 11 types of bacteria recovered from wound samples. Conclusion Early treatment with the joint application of multiple antibacterial agents, early debridement, and adequate drainage all helped to control the infection and avoid nosocomial infection. Employing these strategies in the future will control infection in disaster situations.
Objective To determine the effect of interlocking intramedullary nail in treatment of open tibial and fibula fractures and analyze the method to promote the bone union. Methods From December 2003 to June 2006, thirtyfive patients with open tibial and fibula fracture were treated with emergency debridement, interlocked intramedullary fixation for tibia and fixed fibula at the same time. During operation, the bone marrow was collected and grafted into the fracture gaps. Among them, there were 27 males and 8 females, involving in 22 left legs and 13 right legs. Their ages ranged from 19 to 65 years, with an average of 34.7 years. The location of fracture was the middle of the tibia and fibula in 16 cases, the distal 1/3 of the tibia and fibula in 12 cases and the proximal 1/3 in 7 cases. According to the Gusitilo classification of open injuries, there were 7 cases of type I, 19 cases of type II, 8 cases of type III a and 1 case of type III b. The mean range of knee motion was 48.3° (45-70°). The mean time from injury to operation was 4.3 hours (50 minutes to 7 hours). Results The mean operation time was 94 minutes (60-132 minutes) and the mean blood loss was 122 mL (100-350 mL). The wound healed by first intention in 32 patients. Incision was sutured in 2 cases of type III a fractures after operation 4 days, gastrocnemius flap graft was performed in 1 case of type III b fracture 1 week after operation. They all achieve good heal ing. No fractures spl it off, no iatrogenic nerve and vascular injury occurred, no osteofascial compartment syndromes or deep vein thrombus happened. Tension bl isters appeared in 1 case of type II fracture after operation and subsided after 5 days. Patients were followed up for 14-43 months (mean 22 months). The X-ray films showed that fracture union was observe in 30 cases after 14 weeks of operation, in 3 cases after 18 weeks and in 1 caseafter 22 weeks of operation. The fractures union time was 15.2 weeks on average. About 2 cm nonunion in lateral tibial appeared in 1 case of type I fracture. No fracture occurred again. The mean range of knee motion was 127° (121-135°). The mean HSS score was 96.5 (87-100) at the end of the follow-up. The excellent and good rate was 100%. Conclusion The curative effect of interlocking intramedullary nail is definite in treatment of open tibial and fibula fractures and it can enhance fracture union to plant bone marrow into the fracture gaps.
OBJECTIVE: To investigate the effect of vacuum sealing(VS) technique and emergency internal fixation on the management of limbs open fracture and soft tissue dirty defects. METHODS: Fourteen patients (18 limbs) with open fracture and soft tissue dirty defects were treated by the VS technique and internal fixation after debridement and 14 patients managed by traditional method as control group. Wound surface were covered with polyvinyl alcohol foams with embedded drainage tubes connected with vacuum bottle (negative pressure of 50 to 60 kPa) after wound surface were debrided and fracture were fixed. Wound closure was performed with secondary suturing, or free flap, or loco-regional flap and mesh-grafts after 5 to 7 days. RESULTS: All wound surface healed completely. No complications (systemic and local) were found. After 4-6 months follow-up on average, the fracture healed well. There was significant difference in time of treatment, total cost of treatment and complication rate between 2 groups (P lt; 0.01). CONCLUSION: The VS procedure can drain the wound surface completely, decrease infection rate and stimulate the proliferation of granulation tissue. A combination of VS with emergency internal fixation is a simple and effective method in treatment of limbs open fracture and soft tissue dirty defects.
Objective To explore the effectiveness of mini external fixation device for comminuted open fractures of the metacarpal and phalange. Methods Between October 2009 and April 2011, 33 patients with comminuted open fractures of the metacarpal and phalange were treated with mini external fixation device. There were 25 males and 8 females, aged from 21 to 62 years with an average of 25.5 years. Of 33 cases, 7 were rated as Gustilo type II and 26 as Gustilo type IIIA; 20 cases were diagnosed as having simple metacarpal and phalangeal comminuted fractures and 13 cases as having combined interphalangeal or metacarpophalangeal joint fractures. Partial or complete rupture of tendon was observed in 18 cases. The time between injury and operation was 2-8 hours (mean, 3.7 hours). After one stage debridement and reduction, fracture was fixed with mini external fixation device. Results Primary healing of incision was obtained in 30 cases and no pin hole infection was found. Incision infection occurred in 3 cases and leaded to nonunion. Nonunion also occured in 2 cases of simple metacarpal and phalangeal fractures. The mean follow-up was 8 months (range, 6 months to 1 year). X-ray films showed fracture healing in 13 cases after 8 weeks (8 cases of simple metacarpal and phalangeal fractures and 5 cases of combined interphalangeal or metacarpophalangeal joint fractures), in 12 cases after 12 weeks (7 cases of simple metacarpal and phalangeal fractures and 5 cases of interphalangeal or metacarpophalangeal joint fractures), and in 3 cases of simple metacarpal and phalangeal fractures after 6 months. After removing the mini external fixation device and functional exercise, 3 cases of simple metacarpal and phalangeal comminuted fractures and 4 cases of combined interphalangeal or metacarpophalangeal joint fractures still had joint stiffness, but had no finger rotation and alignment deformity or chronic pain. According to the measurement of total active movement for 28 patients who obtained fracture healing, the results were excellent in 7 cases, good in 12 cases, fair in 5 cases, and poor in 4 cases, the excellent and good rate was 67.9%. Conclusion The mini external fixation device is a good technique for comminuted open fractures of metacarpal and phalange. In patients having comminuted open fractures with interphalangeal or metacarpophalangeal joint fracture, the results are fair or poor.
Objective To compare the clinical results of locking compress plate (LCP) as an external fixator and standard external fixator for treatment of tibial open fractures. Methods Between May 2009 and June 2012, 59 patients with tibial open fractures were treated with LCP as an external fixator in 36 patients (group A), and with standard external fixator in 23 patients (group B). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, location, and interval between injury and surgery between 2 groups (P gt; 0.05). The time of fracture healing and incision healing, the time of partial weight-bearing, the range of motion (ROM) of knee and ankle, and complications were compared between 2 groups. Results The incidence of pin-track infection in group A (0) was significantly lower than that in group B (21.7%) (P=0.007). No significant difference was found in the incidence of superficial infection and deep infection of incision, and the time of incision healing between 2 groups (P gt; 0.05). Deep vein thrombosis occurred in 5 cases of group A and 2 cases of group B, showing no significant difference (χ2=0.036, P=0.085). All patients were followed up 15.2 months on average (range, 9-28 months) in group A, and 18.6 months on average (range, 9-47 months) in group B. The malunion rate and nonunion rate showed no significant difference between groups A and B (0 vs. 13.0% and 0 vs. 8.7%, P gt; 0.05); the delayed union rate of group A (2.8%) was significantly lower than that of group B (21.7%) (χ2=5.573, P=0.018). Group A had shorter time of fracture healing, quicker partial weight-bearing, greater ROM of the knee and ankle than group B (P lt; 0.05). Conclusion The LCP external fixator can obtain reliable fixation in treating tibial open fracture, and has good patients’ compliance, so it is helpful to do functional exercise, improve fracture healing and function recovery, and reduce the complication incidence.
Objective To evaluate the effectiveness of membrane induction technique in the treatment of Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defect. Methods The clinical data of 20 patients with Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defects admitted between January 2019 and December 2020 were retrospectively analyzed, including 15 males and 5 females, with an average age of 35 years (range, 19-70 years). Causes of injuries included 15 cases of traffic accidents and 5 cases of falling from height. Bone defect located at metaphyseal in 11 cases and at proximal metaphyseal in 9 cases. The time from injury to primary first-stage surgery was 4-28 hours, with an average of 11 hours. After primary radical debridement, the length of bone defect was 3-12 cm, with an average of 6 cm. Antibiotic-containing bone cement was implanted in the bone defect site to induce membrane formation. At 34-56 days (mean, 45 days) after the first-stage surgery, bone grafting was performed in the induced membrane for the repair and reconstruction of bone defects; 16 patients received a combination of autogenous cancellous and allogeneic bone grafts and 4 patients received cancellous bone grafts. The bone graft healing time after the second-stage surgery was recorded; the visual analogue scale (VAS) score and Lysholm score were compared before the second-stage bone graft and at last follow-up to evaluate the pain and functional improvement of the affected limb; and the knee joint range of motion at last follow-up was recorded. Results None of the patients had a second revision after the first-stage surgery, 1 patient recieved flap transfer and the flap survived well after operation. All patients were followed up 12-36 months after the second-stage surgery, with an average of 23 months. All patients achieved bone union, and the bone union time was 7-10 months (mean, 8.4 months). No bone nonunion or donor site related complications occurred. The Lysholm score and VAS score at last follow-up were 85.6±4.1 and 1.7±0.8, respectively, and they were significantly improved when compared with those before the second-stage bone defect repair (42.7±4.6 and 7.1±0.8, respectively) (t=37.410, P<0.001; t=21.962, P<0.001). Knee flexion range of motion was 60°-120°, with an average of 95°; the limit of elongation was 0°-10°, with an average of 5°. ConclusionFor Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defect, induction membrane technique can effectively control infection, promote bone healing of the defect site, and effectively restore the function of lower limbs with satisfactory effectiveness.
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.
ObjectiveTo explore the therapeutic effect of using locking compression plate (LCP) as an external fixator and using an external fixator on open fractures of the tibia. MethodsBetween September 2010 and December 2012, 56 patients with the open tibia fractures underwent external fixation using LCP as an external fixator (LCP group, n=22) or external fixator (external fixator group, n=34). We compared the healing time, the rate of postoperative complication and the postoperative function between two groups. ResultsThe mean healing time was 11 weeks (8-28 weeks) and there was 1 case of delayed healing in the LCP group. The mean healing time was 14 weeks and there was 4 cases of delayed healing in the external fixator group. We found significant difference in the healing time (t=2.740, P=0.008) and the infection rate of pin track (13.6% vs 32.4%; χ2=2.496, P=0.114) between the LCP and external fixator group. ConclusionFor open fractures of the tibia, using LCP as an external fixator may increase the healing time and decrease the rate of postoperative complications.