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1.
Bone Joint J ; 103-B(6): 1055-1062, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058873

RESUMO

AIMS: Despite long-standing dogma, a clear relationship between the timing of surgical irrigation and debridement (I&D) and the development of subsequent deep infection has not been established in the literature. Traditionally, I&D of an open fracture has been recommended within six hours of injury based on animal studies from the 1970s, however the clinical basis for this remains unclear. Using data from a multicentre randomized controlled trial of 2,447 open fracture patients, the primary objective of this secondary analysis is to determine if a relationship exists between timing of wound I&D (within six hours of injury vs beyond six hours) and subsequent reoperation rate for infection or healing complications within one year for patients with open limb fractures requiring surgical treatment. METHODS: To adjust for the influence of patient and injury characteristics on the timing of I&D, a propensity score was developed from the dataset. Propensity-adjusted regression allowed for a matched cohort analysis within the study population to determine if early irrigation put patients independently at risk for reoperation, while controlling for confounding factors. Results were reported as odds ratios (ORs), 95% confidence intervals (CIs), and p-values. All analyses were conducted using STATA 14. RESULTS: In total, 2,286 of 2,447 patients randomized to the trial from 41 orthopaedic trauma centres across five countries had complete data regarding time to I&D. Prior to matching, the patients managed with early I&D had a higher proportion requiring reoperation for infection or healing complications (17% vs 13%; p = 0.019), however this does not account for selection bias of more severe injuries preferentially being treated earlier. When accounting for propensity matching, early irrigation was not associated with reoperation (OR 0.71 (95% CI 0.47 to 1.07); p = 0.73). CONCLUSION: When accounting for other variables, late irrigation does not independently increase risk of reoperation. Cite this article: Bone Joint J 2021;103-B(6):1055-1062.


Assuntos
Traumatismos do Braço/cirurgia , Desbridamento , Fraturas Expostas/cirurgia , Traumatismos da Perna/cirurgia , Reoperação/estatística & dados numéricos , Irrigação Terapêutica/métodos , Tempo para o Tratamento , Adulto , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão
2.
Bone Joint J ; 103-B(6): 1160-1167, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058876

RESUMO

AIMS: Open tibial fractures are limb-threatening injuries. While limb loss is rare in children, deep infection and nonunion rates of up to 15% and 8% are reported, respectively. We manage these injuries in a similar manner to those in adults, with a combined orthoplastic approach, often involving the use of vascularised free flaps. We report the orthopaedic and plastic surgical outcomes of a consecutive series of patients over a five-year period, which includes the largest cohort of free flaps for trauma in children to date. METHODS: Data were extracted from medical records and databases for patients with an open tibial fracture aged < 16 years who presented between 1 May 2014 and 30 April 2019. Patients who were transferred from elsewhere were excluded, yielding 44 open fractures in 43 patients, with a minimum follow-up of one year. Management was reviewed from the time of injury to discharge. Primary outcome measures were the rate of deep infection, time to union, and the Modified Enneking score. RESULTS: The mean age of the patients was 9.9 years (2.8 to 15.8), and 28 were male (64%). A total of 30 fractures (68%) involved a motor vehicle collision, and 34 (77%) were classified as Gustilo Anderson (GA) grade 3B. There were 17 (50%) GA grade 3B fractures, which were treated with a definitive hexapod fixator, and 33 fractures (75%) were treated with a free flap, of which 30 (91%) were scapular/parascapular or anterolateral thigh (ALT) flaps. All fractures united at a median of 12.3 weeks (interquartile range (IQR) 9.6 to 18.1), with increasing age being significantly associated with a longer time to union (p = 0.005). There were no deep infections, one superficial wound infection, and the use of 20 fixators (20%) was associated with a pin site infection. The median Enneking score was 90% (IQR 87.5% to 95%). Three patients had a bony complication requiring further surgery. There were no flap failures, and eight patients underwent further plastic surgery. CONCLUSION: The timely and comprehensive orthoplastic care of open tibial fractures in this series of patiemts aged < 16 years resulted in 100% union and 0% deep infection, with excellent patient-reported functional outcomes. Cite this article: Bone Joint J 2021;103-B(6):1160-1167.


Assuntos
Fraturas Expostas/cirurgia , Redução Aberta/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Criança , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Seguimentos , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Centros de Traumatologia
3.
BMJ Case Rep ; 14(4)2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33883117

RESUMO

Rare intraocular complication in a healthy immunocompetent patient with an atypical organism following presumed haematogenous spread after a highly contaminated open tibial fracture.


Assuntos
Endoftalmite , Fraturas Expostas , Fraturas da Tíbia , Endoftalmite/etiologia , Enterococcus , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Humanos , Fraturas da Tíbia/complicações , Fraturas da Tíbia/diagnóstico por imagem
4.
Clin Plast Surg ; 48(2): 267-276, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33674048

RESUMO

Gustilo IIIC injuries of the lower extremity pose a significant challenge to the reconstructive surgeon. Key principles include early vascular repair and serial debridement followed by definitive coverage within 10 days. Primary reconstructive options following vascular repair include the anterolateral thigh flap or the latissimus dorsi muscle flap. Complications include elevated rates of microvascular thrombosis requiring return to the operating room, partial and complete flap loss, and infection. There is also an elevated rate of secondary amputation. However, in spite of higher complication rates, when approached thoughtfully and with an experienced multidisciplinary team, patients can achieve reasonable functional outcomes.


Assuntos
Fraturas Expostas/cirurgia , Traumatismos da Perna/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/cirurgia , Retalhos Cirúrgicos , Adulto , Amputação , Feminino , Humanos , Salvamento de Membro/efeitos adversos , Masculino , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/cirurgia , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
5.
Clin Plast Surg ; 48(2): 277-288, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33674049

RESUMO

In order to address complex extremity injuries, the orthoplastic approach uses plastic, orthopedic, and microsurgical techniques and includes other disciplines to optimize limb salvage. This collaboration, if created early in treatment, allows for more expedient and individualized solutions to a variety of extremity injuries resulting in decreased hospital stay, fewer complications, and improved functional outcomes. The orthoplastic approach does not merely avoid amputation, but also improves patient function and quality of life in the short and long term.


Assuntos
Fraturas Expostas/cirurgia , Extremidade Inferior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/cirurgia , Criança , Feminino , Humanos , Salvamento de Membro/métodos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Radiografia
6.
Clin Plast Surg ; 48(2): 289-297, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33674050

RESUMO

Daily walking stance benefits the health, whereas lower extremity reconstruction aims to accomplish balanced walking and posture control. If local flap or tendon transfer cannot provide the basic function, microsurgical reconstruction is indicated for bony, soft tissue, and sensation restoration. Wound repair can use every modality and can achieve varying wound coverage results. However, all reconstruction should have functional goals using either local flap or free flap to restore the lost function. With less recipient site secondary damage, microsurgery can provide healthy composite tissue with like-replaces-like approach to create more stable long-term results.


Assuntos
Retalhos de Tecido Biológico , Extremidade Inferior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Contratura , Contraindicações de Procedimentos , Feminino , Fraturas Expostas/cirurgia , Humanos , Extremidade Inferior/lesões , Masculino , Microcirurgia/métodos , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Lesões dos Tecidos Moles/cirurgia , Transferência Tendinosa
7.
J Pediatr Orthop ; 41(4): e342-e346, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33560707

RESUMO

BACKGROUND: While supracondylar (SC) fractures are relatively common in children, the incidence of open injuries is believed to be only 1%. Two prior studies on open SC fractures in children reported an increased incidence of vascular injuries. The purposes of our study were to clarify the incidence, associated conditions, and current treatment for open SC fractures. METHODS: The Pennsylvania Trauma Outcome Study database was queried. Subjects age 25 to 156 months old admitted to trauma centers between January 2000 and December 2015 with a SC fracture were included. Controls were those with closed fractures and the study group, those with open injuries. Study variables were age, sex, weight, injury severity score, length of stay (LOS), nerve injury, ipsilateral forearm fracture, compartment syndrome/fasciotomy, requirement for a vascular procedure. Other variables were mode of treatment, provisional reduction, repeat reduction, time interval between referring facility admission and operation, and time from emergency department admission to operation. RESULTS: A total of 4308 subjects were included, 104 (2.4%) of whom had an open SC fracture. LOS was 2 days for the study group versus 1 day for controls (P<0.001). Open SC fractures were more likely than closed to be associated with a nerve injury (13.5% vs. 3.7%), ipsilateral forearm fracture (18.3% vs. 6.4%) and/or a vascular procedure (6.7% vs. 0.3%) (P<0.001). 5.9% of those in the study group required repeat surgery compared with 0.4% for controls (P<0.001). Time from emergency department admission to operation was 3.2 versus 10.3 hours (P<0.001). CONCLUSIONS: We report the largest series to date of open SC fractures in children. Surgeons caring for such patients should be aware of their increased risks for both associated injuries and potential requirement for vascular reconstruction. The majority of children with an open SC fracture are managed with 1 operation and in the absence of vascular injury, seldom require an extended LOS. LEVEL OF EVIDENCE: Level III-retrospective cohort study.


Assuntos
Fraturas Expostas/epidemiologia , Fraturas Expostas/cirurgia , Fraturas do Úmero/epidemiologia , Fraturas do Úmero/cirurgia , Traumatismo Múltiplo/epidemiologia , Criança , Pré-Escolar , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pennsylvania/epidemiologia , Traumatismos dos Nervos Periféricos/epidemiologia , Fraturas do Rádio/epidemiologia , Reoperação , Estudos Retrospectivos , Tempo para o Tratamento , Centros de Traumatologia , Fraturas da Ulna/epidemiologia , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/cirurgia
8.
BMC Musculoskelet Disord ; 22(1): 1, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397351

RESUMO

BACKGROUND: To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. METHODS: From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. RESULTS: Four patients were lost to follow-up, and 87 patients were followed up for 5-35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05). The fracture healing time of group C (5.67 ± 1.42 months) was significantly less than that of group A (6.90 ± 1.33 months) and group B (6.70 ± 1.12 months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05). CONCLUSION: Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.


Assuntos
Fraturas Expostas , Fraturas da Tíbia , Fixadores Externos , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Fixação Interna de Fraturas , Consolidação da Fratura , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Humanos , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
9.
Injury ; 52(3): 402-406, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33341244

RESUMO

BACKGROUND: COVID-19 has created huge pressures on healthcare systems. The ongoing provision of major trauma services during this time has proved challenging. We report our experience of managing open lower limb fractures (oLLFs) during the pandemic in a London major trauma centre (MTC). METHODS: This was a prospective study of all open lower limb fractures presenting to our unit over the initial 48 days of UK government lockdown - 24th March till 10th May 2020. Results were compared to the same time period in 2019 retrospectively. Epidemiological data, mechanism, Gustilo-Anderson (G-A) severity grading, time to initial debridement and definitive coverage were analysed. RESULTS: There was a 64% reduction in emergency department (ED) attendances (25,264 vs 9042). There was an 18% reduction in oLLFs (22 vs 18). Approximately three-quarters of injuries were in males across both cohorts (77% vs 78%) and tended to occur in younger patients (median age, 37 vs 35). Road-traffic-accidents (RTAs) were the most common injury mechanism in both 2019 and lockdown, but a rise in jumpers from height was seen in the latter. A similar pattern of G-A severities were seen, however only 3 injuries during lockdown required major soft tissue reconstruction. There was no significant difference in times taken for initial debridement (p = 0.72786) or definitive wound coverage (p = 0.16152). A greater proportion of independent operating was seen during lockdown between orthopaedics and plastic surgery. CONCLUSIONS: Despite government lockdown measures, oLLFs still placed significant burden on our MTC. Notwithstanding significant staffing alterations and theatre pressures, we have been able to ensure these lower limb emergencies remain a surgical priority and have managed to utilise resources appropriately.


Assuntos
Fraturas do Fêmur/cirurgia , Traumatismos do Pé/cirurgia , Fraturas Expostas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Desbridamento/métodos , Feminino , Fraturas do Fêmur/epidemiologia , Traumatismos do Pé/epidemiologia , Fraturas Expostas/epidemiologia , Retalhos de Tecido Biológico , Humanos , Tempo de Internação , Londres , Masculino , Pessoa de Meia-Idade , Retalho Perfurante , SARS-CoV-2 , Cirurgia Plástica , Retalhos Cirúrgicos , Fraturas da Tíbia/epidemiologia , Fatores de Tempo , Centros de Traumatologia , Técnicas de Fechamento de Ferimentos , Adulto Jovem
10.
Rev. cuba. ortop. traumatol ; 34(2): e231, jul.-dic. 2020. ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1156596

RESUMO

RESUMEN Introducción: Las fracturas abiertas del tercio distal de tibia o pilón son poco frecuentes, en nuestro medio se producen por traumas de alta energía como los accidentes de tránsito, y pueden ser de distintos grados según su envergadura. Entre las complicaciones frecuentes están la seudoartrosis, deformidades y artritis postraumática. Cuando el dolor es refractario a los analgésicos están indicadas las artrodesis. Objetivo: Presentar los resultados del tratamiento realizado en un paciente con seudoartrosis distal de tibia y artritis postraumática del tobillo, dolorosa, con gran lesión de partes blandas, por lo que fue imposible realizar los procedimientos quirúrgicos habituales. Presentación del caso: Se realizó artrodesis de las articulaciones tibio-peronea-astragalina-calcánea, mediante un injerto libre del peroné autólogo, compresión, y estabilización con un fijador externo RALCA®; se asoció un campo electromagnético pulsátil para acelerar la formación del callo óseo y disminuir el dolor posquirúrgico. Durante dos años se le hizo seguimiento. Conclusiones: Se logró el objetivo del tratamiento al fusionar la articulación tibiotarsiana, comenzar el apoyo precoz y su capacidad funcional. Los resultados demuestran además los beneficios de la compresión realizada con los fijadores externos en las artrodesis; el uso del campo electromagnético asociado aceleró la osteogénesis, se consiguió la consolidación ósea, la estabilización, disminuyó el edema y el dolor, además la reincorporación del paciente a la sociedad. No se encontró en la bibliografía revisada otra técnica quirúrgica similar(AU)


ABSTRACT Introduction: Open fractures of the distal third of the tibia or pilon are rare, in our environment they are caused by high-energy traumas such as traffic accidents, and can be of different degrees depending on their size. Common complications include nonunion, deformities, and post-traumatic arthritis. When pain is refractory to analgesics, arthrodesis is indicated. Objective: To report the results of the treatment carried out in a patient with distal tibial pseudoarthrosis and post-traumatic arthritis of the ankle, painful, with a large soft tissue injury, which made it impossible to perform the usual surgical procedures. Case report: Arthrodesis of the tibiofibular-talar-calcaneal joints was performed, using a free graft of the autologous fibula, compression, and stabilization with a RALCA® external fixator. A pulsatile electromagnetic field was associated to accelerate bone callus formation and reduce postoperative pain. This patient was followed up for two years. Conclusions: The treatment objective was achieved by fusing the tibiotarsal joint, by starting early support and functional capacity. The results also prove the benefits of compression performed with external fixators in arthrodesis. The use of the associated electromagnetic field accelerated osteogenesis, bone consolidation and stabilization were achieved, edema and pain decreased, as well as the patient's reincorporation into society. No other similar surgical technique was found in the reviewed literature(AU)


Assuntos
Artrodese/métodos , Pseudoartrose/cirurgia , Fíbula/transplante , Fraturas Expostas/cirurgia
11.
Medicine (Baltimore) ; 99(50): e23704, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327361

RESUMO

RATIONALE: Floating ankle is a rare traumatic condition characterized by a combination of tibial and ipsilateral foot fractures, with the ankle remaining intact. It is usually caused by high-energy trauma and also presents with serious soft tissue damage. Its treatment is mainly restricted to external fixation, which results in poor outcomes. We present a patient with a floating ankle who underwent staged treatment and achieved full internal fixation, subsequently returning to normal activity. PATIENT CONCERNS: A 26 year- old man had an accident with an reel machine and sustained an open fracture on his right lower extremity. DIAGNOSES: Digital radiograph demonstrated a distal tibial fracture, fibular fracture, and multiple metatarsal fractures, which fulfilled the criteria for a floating ankle. INTERVENTIONS: Initial ankle-spanning external fixation was performed. After 21 days, the patient underwent open reduction and internal fixation on his first and fifth metatarsals, and K-wire fixation on his fourth metatarsal. The external fixator was replaced by plaster fixation. Seven days later, the patient underwent internal fixation of his leg, open reduction and internal fixation with plating was applied of the fibular fracture, and minimally invasive plate osteosynthesis of the tibial fracture. OUTCOMES: At 1-year follow-up, bone union was identified by digital radiograph; after 2 years, his ankle function had fully recovered, and he resumed his normal activities. LESSONS: In the staged treatment protocol of the floating ankle, temporary external fixation provided traction and immobilization of the skeletal and soft tissues. Secondary internal fixation maintained the reduction and alignment and allowed early exercise, which is critical to the prognosis of a floating ankle.


Assuntos
Traumatismos do Tornozelo/cirurgia , Ossos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Placas Ósseas , Fios Ortopédicos , Ossos do Pé/lesões , Humanos , Masculino , Amplitude de Movimento Articular
12.
Rev. argent. cir. plást ; 26(3): 143-147, 20200900. fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1151323

RESUMO

El traumatismo de miembros inferiores representa un reto para el cirujano plástico en cuanto a su reconstrucción cuando no se dispone de técnicas microquirúrgicas. En el presente trabajo se presentan tres casos de reconstrucción de rodilla con doble colgajo muscular de gemelo en donde se demuestra que la utilización simultánea de los dos gemelos puede ser aplicada sin dejar ninguna secuela en la parte funcional y estética en la deambulación de los pacientes. No existe en la literatura nacional ni internacional un reporte de casos con esta aplicación, ya que siempre se ha limitado al uso de un solo músculo precisamente por el temor de alterar la función en cuanto a la flexoextensión del pie.


Lower limb trauma is a challenge for plastic surgeons in their reconstruction when microsurgical techniques are available. In this paper we present three cases of reconstruction of the knee with twin double-muscle flap where it is shown that the simultaneous use of the twins can be applied without leaving any sequel partly functional and aesthetics in ambulation of patients. For there is in the national or international literature a repost of cases with this application as it has always been limited to using just a single muscle for fear of disrupting the function in terms of flexion and extension of the foot.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Retalhos Cirúrgicos/cirurgia , Ferimentos e Lesões/classificação , Extremidade Inferior/cirurgia , Fraturas Expostas/cirurgia , Traumatismos do Joelho/cirurgia
13.
J Orthop Traumatol ; 21(1): 10, 2020 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-32683562

RESUMO

BACKGROUND: Open fractures are among the most severe injuries observed in orthopedic patients. Treating open fractures is difficult because such patients with infections may require multiple operations and amputations. Furthermore, only a few studies have focused on antibiotic prophylaxis in open fractures and evaluated how to cover lost soft tissue to increase the success rate of reconstruction. We evaluated the risk factors for deep infection in lower limb Gustilo-Anderson (G-A) type III fractures. MATERIALS AND METHODS: This retrospective study investigated patients who underwent surgical procedures for lower limb G-A type III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G-A type III fractures (77 G-A type IIIA fractures and 37 G-A type IIIB fractures) who were followed up for at least 2 years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G-A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure. RESULTS: Eighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (P < 0.01), G-A classification (P < 0.01), duration of antibiotic prophylaxis (P < 0.01), timing of wound closure (P < 0.01), and incidence of soft-tissue reconstruction failure (P < 0.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (P = 0.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (P < 0.01). CONCLUSION: Early flaps rather than skin grafting should be used to cover G-A type IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures. LEVEL OF EVIDENCE: Level IV retrospective observational study.


Assuntos
Antibacterianos/administração & dosagem , Fraturas Expostas/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Desbridamento , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Expostas/complicações , Fraturas Expostas/tratamento farmacológico , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/microbiologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteomielite/prevenção & controle , Osteomielite/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Fatores de Risco , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/terapia , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/terapia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapia , Fraturas da Tíbia/tratamento farmacológico , Fraturas da Tíbia/microbiologia , Resultado do Tratamento , Adulto Jovem
14.
Orthopade ; 49(8): 679-684, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32671415

RESUMO

Open fractures involve a high risk of open fracture-associated infections (OFAIs), and the treatment can often be protracted and complicated. Thus, prevention of OFAIs in the acute and perioperative management of open fractures is of great importance. Through vigilance and thorough treatment planning, between the day of injury and the hospital discharge, the risk of OFAIs can be considerably reduced.


Assuntos
Infecções Bacterianas/prevenção & controle , Fixação de Fratura/métodos , Fraturas Expostas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção dos Ferimentos/prevenção & controle , Fraturas Expostas/complicações , Humanos , Planejamento de Assistência ao Paciente , Estudos Retrospectivos
15.
J Pediatr Orthop ; 40(6): 288-293, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501910

RESUMO

INTRODUCTION: Timing of wound closure in pediatric Gustilo-Anderson grade II and IIIA open long bone fracture remain controversial. Our aims are (1) to determine the proportion of patients with these fractures whose wounds can be treated with early primary wound closure (EPWC); (2) to compare the complication rates between EPWC and delayed wound closure (DWC); and (3) to determine factors associated with higher likelihood of undergoing DWC. PATIENTS AND METHODS: At a level-1 pediatric trauma center, 96 patients (younger than 18 y) who sustained Gustilo-Anderson grade II and IIIA open long bone fractures (humerus, radius, ulnar, femur, or tibia) within a 10-year period (2006-2016) were included for this study. Decision for EPWC versus DWC was at the discretion of the attending surgeon at time of initial surgery. Data collection was via retrospective review of charts and radiographs. Particular attention was paid to the incidence of return to operating room rate, nonunion, compartment syndrome, and infection. Median follow-up duration was 7.5 months (interquartile range: 3.6 to 25.3 mo). All patients were followed-up at least until bony union. RESULTS: Overall, 81% of patients (78/96) underwent EPWC. Of the grade II fractures, 86% underwent EPWC. Four patients (5%) in the EPWC group and 1 patient (6%) in the DWC group had at least 1 complication. When controlling for mechanism of injury, Gustilo-Anderson fracture type and age, there was no difference in rate of complications between the EPWC and the DWC groups. Grade IIIA fractures and being involved in a motor vehicle accident were factors associated with a higher likelihood of undergoing DWC. CONCLUSION: The majority of grade II and IIIA pediatric long bone fractures may be safely treatable with EPWC without additional washouts. Future prospective research is required to further define the subgroups that can benefit from DWC. LEVEL OF EVIDENCE: Level IV-therapeutic, case cohort study.


Assuntos
Extremidades/lesões , Fraturas Ósseas/cirurgia , Técnicas de Fechamento de Ferimentos , Adolescente , Criança , Feminino , Fraturas Expostas/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/normas , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
16.
Unfallchirurg ; 123(6): 479-490, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32399649

RESUMO

Shaft fractures of the tibia and fibula mainly affect younger patients and are therefore of great socioeconomic importance. Due to the high proportion of high-energy direct trauma mechanisms and the thin soft tissue covering layer of the ventromedian tibia, open factures occur in up to 39%. A structured diagnostic and therapeutic approach is essential for successful treatment. Reamed intramedullary nailing is currently the gold standard surgical procedure. The suprapatellar approach, representing an interesting alternative to the popular infrapatellar approach, postoperative complications, such as anterior knee pain as well as the management of non-unions are discussed in this article. Furthermore, the indications and the application of minimally invasive plate osteosynthesis (MIPO) and external fixators are described. Every trauma surgeon should be familiar with the etiology and the surgical treatment of compartment syndrome. A firm knowledge of the classifications of open and closed soft tissue injury is mandatory.


Assuntos
Síndromes Compartimentais/cirurgia , Fíbula/lesões , Fraturas da Tíbia/cirurgia , Adulto , Placas Ósseas , Síndromes Compartimentais/etiologia , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Fixação Intramedular de Fraturas , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Fraturas Expostas/diagnóstico , Fraturas Expostas/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Lesões dos Tecidos Moles/classificação , Lesões dos Tecidos Moles/cirurgia , Fraturas da Tíbia/diagnóstico , Resultado do Tratamento
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(4): 447-451, 2020 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-32291979

RESUMO

Objective: To compare the effectiveness of Taylor spatial frame (TSF) and unilateral external fixator in the treatment of tibiofibular open fractures. Methods: Between January 2016 and July 2018, 74 patients with tibiofibular open fracture who met the selection criteria were divided into TSF group (43 cases, fixed with TSF) and unilateral group (31 cases, fixed with unilateral external fixator) according to the principle of entering the group every other day. There was no significant difference in gender, age, affected side, cause of injury, type of fracture between the two groups ( P>0.05). The operation time, fracture healing time, removal time of external fixator, and complications were recorded and compared between the two groups. The limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effectiveness of tibial shaft fracture treatment. The recovery of lower limb force line was ecaluated by LUO Congfeng et al. criteria. Results: All patients were followed up 8-22 months, with a median of 12 months. All fractures healed, and no complication such as delayed union, nonunion, or osteomyelitis occurred. The operation time, fracture healing time, and removal time of external fixator in TSF group were significantly shorter than those in unilateral group ( P<0.05). At 3 months after the removal of the external fixator, the limb function was evaluated according to the Johner-Wruhs standard. In TSF group, 41 cases were excellent, 1 case was good, and 1 case was fair, and the excellent and good rate was 97.67%; in unilateral group, 30 cases were excellent and 1 case was fair, and the excellent and good rate was 96.77%; there was no significant difference between the two groups ( P=0.666). At 4 months after operation, the recovery of lower limb force line was ecaluated by LUO Congfeng et al. criterion. In TSF group, 41 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 97.67%; in unilateral group, 29 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was 96.77%; there was no significant difference between the two groups ( P=0.666). Conclusion: For tibiofibular open fracture, on the premise of fracture healing, TSF technology is superior to unilateral external fixation in terms of shortening operation time, fracture healing time, and removal time of external fixator.


Assuntos
Fixadores Externos/classificação , Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Consolidação da Fratura , Humanos , Resultado do Tratamento
18.
Acta Orthop ; 91(4): 439-443, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32285734

RESUMO

Background and purpose - High-energy trauma to the lower limbs can result in open fractures, treated by reconstructive surgery or amputation. We examined whether socioeconomic position is associated with choice of primary treatment.Patients and methods - We performed a nationwide population-based study using the Swedish National Patient Register to identify all adult patients who between 1998 and 2013 underwent reconstruction or amputation after an open fracture below the knee. Information on socioeconomic position was collected from Statistics Sweden.Results - Of 275 individuals undergoing surgery after an open fracture below the knee during the study period, the 1st surgery was reconstructive in 58% of the patients and amputation in 42%. The chance of having an initial reconstruction was lower for women than for men (OR 0.5, 95% CI 0.3-0.9), lower with age (OR 0.97, CI 0.96-0.99), and lower for individuals without employment compared with individuals in employment (OR 0.3, CI 0.2-0.5). Primary treatment was in women associated with family composition, whereas in men it was associated with level of education.Interpretation - Choice of primary treatment after open fracture in the lower limb is affected by socioeconomic position including sex, age, employment, family composition, level of education, and income.


Assuntos
Amputação/estatística & dados numéricos , Fraturas Expostas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Emprego/estatística & dados numéricos , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores Sexuais , Fatores Socioeconômicos , Suécia , Adulto Jovem
20.
Orthop Surg ; 12(2): 524-532, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32202051

RESUMO

OBJECTIVE: To analyze the relationship between the length from injury to first debridement (LFITFD) of open tibial fractures and perioperative infection, and explore independent risk factors related to infection. METHODS: This retrospective study focused on 215 clinical patients with open tibial fractures who were admitted from January 2012 to January 2017. According to the time from injury to the operation, the patients were categorized into four groups: LFITFD ≤ 6 h, 6 < LFITFD ≤ 12 h, 12 < LFITFD≤24 h, and (LFITFD > 24 h). Infection risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors. RESULTS: The infection rates of four groups were 9.2%, 9.5%, 11.1%, and 10.5% with six of 65, nine of 95, four of 36, and two of 19 patients being infected, respectively. There was no statistical significance between the four groups. The infection rates among fractures of different Gustilo-Anderson classifications were as follows. Of 62 cases of type I fractures, two were infected, and the infection rate was 3.2%. Among those with type II fractures, eight were infected, and the infection rate was 8.2%. Three of 26 cases of type IIIA fracture were infected, yielding an infection rate of 11.5%, seven of 25 cases of type III B fracture were infected (28% infection rate), and one of four cases of type III C fracture was infected (25% infection rate). There was a statistically significant difference between the five groups. Multivariate regression analysis showed that smoking, combined diabetes, surgical time, and fracture Gustilo-Anderson classification were independent risk factors for perioperative infection of open tibial fractures, and the difference in time from injury to first debridement was not related to infection. CONCLUSION: The incidence of perioperative infection in patients with open tibial fractures has little to do with the time of the first debridement, which is mainly related to the level of the fracture's Gustilo-Anderson classification. At the same time, smoking is prohibited before the operation, the patient's blood glucose is managed, and the debridement operation time is minimized conducive to reducing the incidence of infection.


Assuntos
Desbridamento , Fraturas Expostas/complicações , Fraturas Expostas/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Fraturas da Tíbia/cirurgia , Tempo para o Tratamento , Adulto , Feminino , Fixação de Fratura , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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